Outcomes of Patients with Malignancy Admitted to the Intensive Care Units: A Prospective Study

Abstract

Introduction. Decisions regarding whether advanced cancer patients should be admitted to the ICU are based on a complex suite of considerations, including short- and long-term prognosis, quality of life, and therapeutic options to treat cancer. We aimed to describe demographic, clinical, and survival data and to identify factors associated with mortality in critically ill advanced cancer patients with nonelective admissions to general ICUs. Materials and Methods. Critically ill adult (≥18 years old) cancer patients nonelectively admitted to the intensive care units at the American University of Beirut Medical Center between August 1st 2015 and March 1st 2019 were included. Demographic, clinical, and laboratory data were prospectively collected from the first day of ICU admission up to 30 days after discharge. This study was strictly observational, and clinical decisions were left to the discretion of the ICU team and attending physician. Results. 272 patients were enrolled in the study between August 1st 2015 and March 1st 2019, with an ICU mortality rate of 43.4%, with the number rising to 59% within 30 days of ICU discharge. The mean length of stay in our ICU was 14 days (IQR: 1–120) with a median overall survival of 22 days since the date of ICU admission. The major reasons for unplanned ICU admission were sepsis/septic shock (54%) and respiratory failure (33.1%). Cox regression analysis revealed 7 major predictors of poor prognosis. Direct admission from the ED was associated with a higher risk of mortality (48.9%) than being transferred from the floor (32.6%) ( p = 0.014 ). Conclusion. Our study has shown that being directly admitted to the ICU from the ED rather than being transferred from regular wards, developing AKI, sepsis, MOF, and ARDS, or having an uncontrolled malignancy are all predictive factors for short-term mortality in critically ill cancer patients nonelectively admitted to the ICU. Vasopressor use and mechanical ventilation were also predictors of mortality.

Association Of Potassium Concentration And Variability With Mortality Among Patients Requiring Continuous Renal Replacement Therapy In Intensive Care Units: A Hospital-Based Retrospective Cohort Study

“…On the contrary, the delayed strategy of CRRT was associated with increased risk, similar to the result in the ELAIN randomized clinical trial [30]. In addition, vasopressors therapy and the presence of malignancy were also risk factors for mortality, and the association has been reported in previous studies [31][32]. It's noteworthy that our study was observed marginally lower mortality with higher body temperature.…”

Características e desfechos de pacientes oncológicos com infecção em unidade de terapia intensiva

“…A prevalence of solid tumors can be observed, which corroborates other studies (Abou Dagher et al, 2017; Assi et al, Research, Society and Development, v. 11, n. 9, e0611931452, 2022(CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i9.31452 2021Cunha et al, 2018;Marcio Soares et al, 2016), however, the breast tumor was more frequently found, differing from those that showed a higher occurrence of lung cancer (Abou Dagher et al, 2017;Assi et al, 2021). As for hematological tumors, lymphoma (Hodgkin and non-Hodgkin) was the type of cancer that was present in most patients.…”

“…This fact is associated with a death rate of 53.8%, the main outcome found. The data show a higher death rate than previous studies that bring rates ranging from 21 to 43.4% (Assi et al, 2021;Hawari et al, 2016;Marcio Soares et al, 2016).…”

“…The average length of stay in the ICU found was longer than other studies, which show an average of 3 to 5 days (Hawari et al, 2016;Márcio Soares et al, 2010;Torres et al, 2016). However, it was shorter than found in a study at the American University of Beirut Medical Center, which averaged 14 days (Assi et al, 2021). The main reason for hospitalization among patients was for respiratory causes, similar to studies carried out in European ICUs and in an ICU in the Middle East (Hawari et al, 2016;Taccone et al, 2009).…”

First 24-Hour Potassium Concentration and Variability and Association with Mortality in Patients Requiring Continuous Renal Replacement Therapy in Intensive Care Units: A Hospital-Based Retrospective Cohort Study

“…By contrast, the delayed initiation of CRRT was associated with an increased risk of mortality, which is similar to the result of the ELAIN randomized clinical trial [ 31 ]. In addition, vasopressor therapy and the presence of malignancy were determined as risk factors for mortality in previous studies [ 32 , 33 ]. A marginally lower mortality was observed in the patients with higher body temperature in our study.…”