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- Title
Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study.
- Authors
Zampieri, Fernando G.; Romano, Thiago G.; Salluh, Jorge I. F.; Taniguchi, Leandro U.; Mendes, Pedro V.; Nassar, Antonio P.; Costa, Roberto; Viana, William N.; Maia, Marcelo O.; Lima, Mariza F. A.; Cappi, Sylas B.; Carvalho, Alexandre G. R.; De Marco, Fernando V. C.; Santino, Marcelo S.; Perecmanis, Eric; Miranda, Fabio G.; Ramos, Grazielle V.; Silva, Aline R.; Hoff, Paulo M.; Bozza, Fernando A.
- 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.
- Subjects
CANCER patients; COHORT analysis; HOSPITAL admission &; discharge; ARTIFICIAL respiration; LUNG cancer
- Publication
Intensive Care Medicine, 2021, Vol 47, Issue 2, p170
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-020-06184-2