Outcome of Critically Ill Patients With Testicular Cancer Admitted to the ICU

Abstract

PURPOSE: To evaluate the clinical characteristics and hospital outcomes of critically ill patients with testicular cancer (TC) admitted to an oncological intensive care unit (ICU). METHODS: Prospective observational study from February 2008 to February 2015 in the ICU of the Instituto Nacional de Cancerologia (INCan) located in Mexico City. There were no interventions. Sixty patients with TC were admitted to the ICU. Continuous variables are expressed as means AE standard deviation or as medians and interquartile ranges. Categorical variables are expressed as percentage. Student's t-test or the Mann-Whitney U-test were used to compare continuous variables, and the chisquared or Fisher's exact test was used to compare categorical variables. Cox proportional hazards univariate and multivariate analysis were used to identify factors with potential prognostic significance with 6-month survival. Results were reported using hazard ratios (HRs) and corresponding 95% confidence interval (CI). A two-sided P-value <0.05 was used to determine statistical significance. RESULTS: During the study period, 60 patients with TC were admitted to the ICU of the INCan. The mean age of the patients was 28.3 AE 8.2 years. The most common histologic type was non-seminomatous germ cell tumors (91.7%). Forty-nine patients (81.7%) were classified as having a poor prognosis, 9 patients (15%) as intermediate prognosis and 2 patients (3.3%) as good prognosis. During the first 24 hours of ICU admission, invasive mechanical ventilation was required by 43 patients (71.6%) for a median duration of 3 days (interquartile range, 1-7), and vasopressors were required by 27 patients (24%). The median length of stay in the hospital wards before ICU admission was 2 days (1-7). The length of stay in the ICU and hospital were 3 (2-6) and 8 (5-15) days, respectively. The ICU, hospital, and 6-month mortality rates were 38.3, 45, and 63.3%, respectively. Cox multivariate analysis identified the white blood cells count (HR¼1.06, 95%CI¼1.01-1.11, P¼0.005), ionized calcium (HR¼1.23, 95% CI¼1.01-1.50, P¼0.037), and 2 or more organ failure during the first 24 hours after ICU admission (HR¼3.86, 95%CI ¼ 1.96-7.59, P<0.001) as independent predictors of death to 6 months. CONCLUSIONS: The ICU, hospital, and 6-month rates were 38.3, 45, and 63.3%, respectively. The factors associated with increased 6-month mortality rate were the white blood cells count, the ionized calcium, and 2 or more organ failure during the first 24 hours after ICU admission. CLINICAL IMPLICATIONS: The results of this study suggest that 6-month mortality rates in critically ill patients with TC depends primarily on the number of organ dysfunctions, especially when 2 or more organs are affected. The ICU should be involved with prevention, early detection and early treatment of organ dysfunction. Aggressive early supportive treatment could reduce the impact of organ dysfunctions on mortality.