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Background: Risk of acute organ failure (AOF) in cancer patients on systemic antineoplastic treatment is unknown. However, up to 5% of non-hematologic and 15% of hematologic cancer patients will need to be admitted to an intensive care unit (ICU). IPOPSCI-2017/01 is a prospective cohort study designed to ascertain the cumulative incidence of AOF and ICU admission in adult cancer patients. Methods: Single centre prospective cohort study with consecutive sampling of adult cancer patients admitted for unscheduled inpatient care while on, or up to 8 weeks after, systemic cancer treatment. Primary endpoints were cumulative risk of developing AOF and of ICU admission. Six months accrual expected an accrual of 400 patients to infer a population risk of ICU admission with a precision error of 2% and type 1 error of 5%. Results: Between August 2018 and February 2019, 10392 patients were on systemic anti-neoplastic treatment, 358 had unscheduled inpatient care and were eligible for inclusion and 285 were included. Mean age was 60.9 years-old, 50.9% were male, 52.3% had adjusted Charlson Comorbidity Index ≥3 and hematologic cancers accounted for 17.9% of patients. The cumulative risk of AOF on hospital admission was 29.5% (95%CI: 26-33) and during hospital stay was 39.6% (95%CI: 35-44). Cumulative risk of ICU admission of the patients with AOF was 15.0% (95%CI: 12-18) and if artificial life support criteria and AOF, cumulative risk of ICU admission was 31.5% (95%CI:CI: 23-40). On admission, 62.1% of patients were considered not eligible for artificial organ replacement therapy (no-AORT) and 34.3% of patients who developed AOF while in-hospital were judged no-AORT. Overall, 17 (15%) patients with AOF were admitted to ICU, 31.5% for AORT. Median follow up was 9.5 months. Inpatient mortality was 17.5%, with ICU mortality rate of 58.8%, with median cohort survival 134 days (95%CI: 106-162). On multivariate analysis, AOF was an independent poor prognostic factor (HR 1.6; 95%CI: 1.2-2.2). Conclusions: Risk of AOF in cancer patients admitted for unscheduled inpatient care while on systemic treatment is 39.6%, and risk of ICU admission is 15.0%. AOF in cancer patients was an independent poor prognostic factor for inpatient hospital stay and 6-months survival.

Territoire riche d’une exceptionnelle biodiversité soumis à une intense activité humaine, la Méditerranée doit faire face à de nombreux enjeux au regard du changement climatique. Elle a toutefois beaucoup de possibilités pour relever ces défis en s’investissant dans la définition de solutions bâties sur un dialogue élargi à tous les acteurs de la région. C’est précisément le rôle de l’Union pour la Méditerranée de faire émerger des initiatives visant à renforcer la coopération dans ce domaine. Malgré le caractère très récent de son mandat politique sur les questions climatiques - qui date de mai 2014 -, l’Union pour la Méditerranée, à travers notamment son Groupe d’experts sur le changement climatique, a d’ores et déjà entrepris d’identifier des initiatives phares concrètes pour mieux répondre aux enjeux en question.

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