One-year survival of patients with high-grade glioma discharged alive from the intensive care unit
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ORIGINAL COMMUNICATION
One‑year survival of patients with high‑grade glioma discharged alive from the intensive care unit Maxens Decavèle1,2 · Nicolas Gatulle1 · Nicolas Weiss3,4 · Isabelle Rivals2,5 · Ahmed Idbaih6 · Sophie Demeret3 · Julien Mayaux2 · Martin Dres1,2 · Elise Morawiec2 · Khe Hoang‑Xuan6 · Thomas Similowski1,2 · Alexandre Demoule1,2 Received: 12 July 2020 / Revised: 24 August 2020 / Accepted: 26 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Only limited data are available regarding the long-term prognosis of patients with high-grade glioma discharged alive from the intensive care unit. We sought to quantify 1-year mortality and evaluate the association between mortality and (1) functional status, and (2) management of anticancer therapy in patients with high-grade glioma discharged alive from the intensive care unit. Patients and methods Retrospective observational cohort study of patients with high-grade glioma admitted to two intensive care units between January 2009 and June 2018. Functional status was assessed by the Karnofsky Performance Status. Anticancer therapy after discharge was classified as (1) continued (unchanged), (2) modified (changed or stopped), or (3) initiated (for newly diagnosed disease). Results Ninety-one high-grade glioma patients (73% of whom had glioblastoma) were included and 78 (86%) of these patients were discharged alive from the intensive care unit. Anticancer therapy was continued, modified, and initiated in 41%, 42%, and 17% of patients, respectively. Corticosteroid therapy at the time of ICU admission [odds ratio (OR) 0.07] and cancer progression (OR 0.09) was independently associated with continuation of anticancer therapy. The mortality rate 1 year after ICU admission was 73%. On multivariate analysis, continuation of anticancer therapy (OR 0.18) and Karnofsky performance status on admission (OR 0.90) were independently associated with lower 1-year mortality. Conclusion The presence of high-grade glioma is not sufficient to justify refusal of intensive care unit admission. Performance status and continuation of anticancer therapy are associated with higher survival after intensive care unit discharge. Previous presentation Preliminary results were presented at the most recent congress of the French Intensive Care Society, Paris, 2019. Keywords Malignant brain tumors · Glioma · One-year survival · Intensive care unit · Anticancer therapy · Performance status
Introduction Patients with solid tumor or hematologic malignancies account for 20% of intensive care unit (ICU) admissions [1, 2]. Because the prognosis of cancer patients is similar to that of non-cancer patients [1, 3], a diagnosis of cancer should not preclude ICU admission. This general rule also applies Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-10191-0) contains supplementary material, which is available to authorized users. * Maxens Decavèle [email protected] Extended author
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