One-year survival of patients with high-grade glioma discharged alive from the intensive care unit

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

Outcome of glioblastoma patients after intensive care unit admission with invasive mechanical ventilation: a multicenter analysis

“…In contrast to our study, only a subset of patients (< 50%) was invasively mechanically ventilated in other studies with primary brain tumors and the length of stay at ICU was shorter [ 9 , 11 ]. This and other aspects as well as the selection for glioblastoma, which is connected with a specifically unfavorable prognosis, may contribute to the in-hospital mortality of 60,6% in our cohort, which is higher than reported in cohorts of primary brain tumor patients [ 10 , 18 ] and solid cancer patients [ 13 – 15 ]. Furthermore, patients with glioblastoma experience not only complications of tumor disease and therapy but also neurological complications with unfavorable prognosis.…”

“…Approximately half of the survivors in follow-up lived longer than one year after ICU discharge, which is a considerable high survivor rate also in view of other publications [ 18 ]. As expected, glioblastoma progression was the main reason for death in our cohort of survivors.…”