Admission factors associated with intensive care unit readmission in critically ill oncohematological patients: a retrospective cohort study

Abstract

ObjectiveThe purpose of our study was to determine the admission factors associated with intensive care unit readmission among oncohematological patients.MethodsRetrospective cohort study using an intensive care unit database from a tertiary oncological center. The participants included 1,872 critically ill oncohematological patients who were admitted to the intensive care unit from January 2012 to December 2014 and who were subsequently discharged alive. We used univariate and multivariate analysis to identify the admission risk factors associated with later intensive care unit readmission.ResultsOne hundred seventy-two patients (9.2% of 1,872 oncohematological patients discharged alive from the intensive care unit) were readmitted after intensive care unit discharge. The readmitted patients were sicker compared with the non-readmitted group and had higher hospital mortality (32.6% versus 3.7%, respectively; p < 0.001). In the multivariate analysis, the independent risk factors for intensive care unit readmission were male sex (OR: 1.5, 95% CI: 1.07 - 2.12; p = 0.019), emergency surgery as the admission reason (OR: 2.91, 95%CI: 1.53 - 5.54; p = 0.001), longer hospital length of stay before intensive care unit transfer (OR: 1.02, 95%CI: 1.007 - 1.035; p = 0.003), and mechanical ventilation (OR: 2.31, 95%CI: 1.57 - 3.40; p < 0.001).ConclusionsIn this cohort of oncohematological patients, we identified some risk factors associated with intensive care unit readmission, most of which are not amenable to interventions. The identification of risk factors at intensive care unit discharge might be a promising approach.

Biomarkers as predictors of mortality in critically ill patients with solid tumors

“…Mortality in onco-hematologic patients was analyzed in a cohort, which found that ICU readmissions increased mortality by 10-fold. Still they found that the male, emergency surgery, length of hospital stays before ICU transfer and mechanical ventilation (MV) were independently associated (Rodrigues et al 2016). Most of these risk factors are due to disease severity or previous chronic health problems.…”

To: Admission factors associated with intensive care unit readmission in critically ill oncohematological patients: a retrospective cohort study

“…Although Rodrigues et al mentioned in their discussion that oncohematological patients are more susceptible to post-ICU complications that require readmission, such as treatment-related immune suppression, cancer-associated malnutrition, invasive procedures, repeated surgeries, and increased thrombotic tendency, they did not include these important parameters into univariate and multivariate analyses. ( 1 ) We believe that these parameters would reflect the readmission risk factors of oncohematological patients more effectively than the rest of the parameters that were included in this study.…”

“…We read the manuscript by Rodrigues et al in the latest issue of Revista Brasileira de Terapia Intensiva Journal with great interest. ( 1 ) In this single-center, retrospective, observational cohort study, Rodrigues et al aimed to identify risk factors associated with later readmission to the intensive care unit (ICU) among critically ill oncohematological patients by evaluating their first ICU admissions. They identified male sex, emergency surgery as the admission reason, longer length of hospital stay before ICU transfer and mechanical ventilation (MV) as independent risk factors for ICU readmissions.…”

“…According to this categorization, Rodrigues et al ( 1 ) should also have presented the first ICU admission characteristics of their patient group. They identified the length of hospital stay before ICU transfer as an independent predictor of readmission but did not take into consideration the length of ICU stay or the length of MV during patients' first ICU admission.…”

“…Second of all, physiological characteristics, laboratory abnormalities and severity of illness at the time of ICU discharge were not evaluated as risk factors of readmission by Rodrigues et al ( 1 ) In assessing readmissions, it is important to consider characteristics of the patients' discharge status, including the hemodynamic status, laboratory parameters for arterial blood gas analysis, discharge Simplified Acute Physiology Score (SAPS 2) or Acute Physiology and Chronic Health disease Classification System II (APACHE II) score, discharge organ dysfunction status (liver and renal functional tests and neurological status) and discharge infection and immune suppression status. ( 2 - 5 ) The Stability and Workload Index for Transfer (SWIFT) score, as Rodrigues et al also mentioned in their discussion, would be more suitable for evaluating readmissions ( 2 , 3 ) in this study.…”