Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a
- PDF / 3,616,621 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 89 Downloads / 140 Views
ORIGINAL
Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study Fernando G. Zampieri1,2,3, Thiago G. Romano4,5,9, Jorge I. F. Salluh6, Leandro U. Taniguchi7,8, Pedro V. Mendes4,8,9, Antonio P. Nassar Jr10, Roberto Costa11, William N. Viana12, Marcelo O. Maia13,14, Mariza F. A. Lima15, Sylas B. Cappi16, Alexandre G. R. Carvalho17, Fernando V. C. De Marco18, Marcelo S. Santino19, Eric Perecmanis20, Fabio G. Miranda21, Grazielle V. Ramos6, Aline R. Silva6, Paulo M. Hoff1,22, Fernando A. Bozza6,23 and Marcio Soares6* © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Abstract Purpose: To describe trends in outcomes of cancer patients with unplanned admissions to intensive-care units (ICU) according to cancer type, organ support use, and performance status (PS) over an 8-year period. Methods: We retrospectively analyzed prospectively collected data from all cancer patients admitted to 92 medical–surgical ICUs from July/2011 to June/2019. We assessed trends in mortality through a Bayesian hierarchical model adjusted for relevant clinical confounders and whether there was a reduction in ICU length-of-stay (LOS) over time using a competing risk model. Results: 32,096 patients (8.7% of all ICU admissions; solid tumors, 90%; hematological malignancies, 10%) were studied. Bed/days use by cancer patients increased up to more than 30% during the period. Overall adjusted mortality decreased by 9.2% [95% credible interval (CI), 13.1–5.6%]. The largest reductions in mortality occurred in patients without need for organ support (9.6%) and in those with need for mechanical ventilation (MV) only (11%). Smallest reductions occurred in patients requiring MV, vasopressors, and dialysis (3.9%) simultaneously. Survival gains over time decreased as PS worsened. Lung cancer patients had the lowest decrease in mortality. Each year was associated with a lower sub-hazard for ICU death [SHR 0.93 (0.91–0.94)] and a higher chance of being discharged alive from the ICU earlier [SHR 1.01 (1–1.01)]. Conclusion: Outcomes in critically ill cancer patients improved in the past 8 years, with reductions in both mortality and ICU LOS, suggesting improvements in overall care. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised PS. Keywords: Cancer, Mortality trends, Critical care, Multicenter study, Bayesian analysis Introduction *Correspondence: [email protected] 6 Department of Critical Care and Graduate Program in Translational Medicine, D’Or Institute for Research and Education, Rio de Janeiro, Brazil Full author information is available at the end of the article
The number of cancer patients admitted to intensive care units (ICU) is rising [1–3]. Many patients are admitted for postoperative care after major surgical resections and generally present with good outcomes with low hospital mortality [3]. However, despite recent improvements in cancer care, the occurrence of life-thr
Data Loading...
