ICU, hospital and one year mortality of patients suffering from solid or haematological malignancies

Unseld, Simone; Schuepbach, Reto A.; Maggiorini, Marco

doi:10.4414/smw.2013.13741

Cited by 10 publications

(15 citation statements)

References 33 publications

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“…Again, the study of Oeyen et al included both planned and unplanned ICU patients. Finally, the 1-year mortality of cancer patients in our study was lower than that of studies with smaller sample size from Spain, Austria and Switzerland (21)(22)(23). Apart from sample size, there is no evident difference in case-mix between our study and these studies, supporting an improvement in long-term survival in this population.…”

Section: Discussioncontrasting

confidence: 52%

“…As noted before, large long-term mortality studies in cancer patients with an unplanned ICU admission are scarce and outdated (18)(19)(20)(21)(22)(23). Potential differences in case-mix between our study and previous literature makes direct comparison di cult.…”

Section: Discussionmentioning

confidence: 78%

“…However, studies regarding long-term mortality after an unplanned ICU admission in patients with a malignancy are scarce and outdated (18)(19)(20)(21)(22)(23). An update of data regarding long-term outcome of cancer patients with an unplanned ICU admission is necessary for two reasons.…”

Section: Introductionmentioning

confidence: 99%

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One-Year Mortality of Cancer Patients with an Unplanned ICU Admission: A Cohort Analysis Between 2008 and 2017 in the Netherlands

Zee

Termorshuizen

Benoît

et al. 2020

Preprint

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BackgroundOver the last decades, a decrease in short-term mortality in cancer patients admitted to the ICU has been described in literature. However, it is unclear whether this decrease also results in a decrease in long-term mortality. Therefore, we examined the 1-year mortality of cancer patients (either haematological or solid) with an unplanned ICU admission.Methods and dataAll adult patients registered in the National Intensive Care Evaluation registry with an unplanned ICU admission in the Netherlands between 2008 and 2017 were included. The primary outcome was 1-year mortality, analysed with a mixed-effects cox-proportional hazard regression. We examined the trend in mortality rates over the inclusion period. Furthermore, we compared the 1-year mortality of cancer patients to that of patients without cancer. ResultsWe included 470,305 patients: 10,401 with haematological cancer, 35,920 with solid tumours, and 423,984 without cancer. The 1-year mortality rates were 60.1%, 46.2%, and 28.3% (p<0.01), respectively. While no statistically significant trend was found (p=0.58), a visual inspection of the graph showed a slightly decreasing trend in 1-year mortality over the inclusion period. Although we found a statistical significant difference in 1-year mortality in patients with a solid tumour (p<0.01), visual inspection showed a wide variety per year. We found a decreasing trend in 1-year mortality in ICU patients without a malignancy (p<0.01). Cancer patients surviving their critical illness and hospital admission had a 30% mortality at 1 year. ConclusionThe 1-year mortality in cancer patients with an unplanned ICU admission (either haematological or solid) was significantly higher than that of patients without cancer. A visual inspection showed a slight decrease in 1-year mortality in haematological patients, while the 1-year mortality in patients with a solid tumour varied per year. After hospital discharge, a considerable part of the patients with a malignancy died within 1 year. Physicians should discuss the long-term prognosis after an ICU admission with patients and relatives in order to manage treatments and expectations. Future research should focus on identifying cancer patients who will benefit from an ICU admission.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 78%

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One-Year Mortality of Cancer Patients with an Unplanned ICU Admission: A Cohort Analysis Between 2008 and 2017 in the Netherlands

Zee

Termorshuizen

Benoît

et al. 2020

Preprint

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“…This percentage was higher than the one reported in other study performed in the same ICU (31.6 % for septic and hypovolemic shock) [ 14 ]. Reports from other parts of the world not even include hypovolemic shock within the first causes of admission to ICU [ 15 – 17 ]. One possible explanation for the high percentage we found, is that patients admitted to our hospital have advanced cancer stages, with tumor adhesion to adjacent organs, therefore require extensive surgeries, with multiple organ resection, which increases bleeds and surgical morbidity.…”

Section: Discussionmentioning

confidence: 99%

Hospital-acquired infections at an oncological intensive care cancer unit: differences between solid and hematological cancer patients

et al. 2016

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BackgroundCancer patients have a higher risk of severe sepsis in comparison with non-cancer patients, with an increased risk for hospital-acquired infections (HAI), particularly with multidrug resistant bacteria (MDRB). The aim of the study is to describe the frequency and characteristics of HAI and MDRB in critically ill cancer patients.MethodsWe conducted an 18-month prospective study in patients admitted ≥48 h to an ICU at a cancer referral center in Mexico. Patients with hematological malignancies (HM) were compared with solid tumors. Demographic and clinical data were recorded. Mortality was evaluated at 30-days.ResultsThere were 351 admissions during the study period, among whom 157 (66 %) met the inclusion criteria of the study as follows: 104 patients with solid tumors and 53 with HM. Sixty-four patients (40.7 %) developed 95 episodes of HAI. HAI rate was 4.6/100 patients-days. MDRB were isolated in 38 patients (24 %), with no differences between both groups. Escherichia coli was the main bacteria isolated (n = 24), 78 % were extended spectrum beta-lactamases producers. The only risk factor associated with HAI was the presence of mechanical ventilation for more than 5 days (OR 3.12, 95 % CI 1.6 – 6.2, p = 0.001). At 30-day follow-up, 61 patients (39 %) have died (38 % with solid tumors and 60 % with HM, p < 0.001). No differences were found in mortality at 30-day between patients with HAI (n = 25, 39 %) vs. non-HAI (n = 36, 38.7 %, p = 0.964); neither in those who developed a HAI with MDRB (n = 12, 35.3 %) vs. HAI with non-MDRB (n = 13, 43.3 %, p = 0.51).ConclusionsPatients with cancer who are admitted to an ICU, have a high risk of HAI, but there were no differences patients with solid or hematologic malignancies.

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“…Hematological malignancies (HM) are the cause of many deaths worldwide and the incidence is increasing day by day (1). Concentrated chemotherapy, stem cell transplants and biological treatment modalities increased remission rates; whereas complications such as leukopenia-related infection, drug toxicity and thrombocytopenia that require intensive care unit (ICU) are also increasing (2). The mortality and cost of intensive care for leukemia and lymphoma patients are higher than in any other patient group (3).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of National Early Warning System for Mortality in Hematological Malignancy Patients Admitted to Intensive Care Unit: Prospective, Single Center, Observational Study

Ileri¹,

Coşkun²,

Temel³

et al. 2020

Crit Intensive Care

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Objective: Hematological malignancies (HM) are the cause of many deaths worldwide and the incidence is increasing day by day. New treatment models increase remission rates; but complications that require intensive care unit (ICU) are also increasing. The aim of this study was to investigate the effect of The National Early Warning System Score (NEWSS) on ICU mortality in HM patients. Methods: This study was performed prospectively in the medical ICU. Patients transferred from hematology ward to the medical ICU were included in the study. NEWSS was calculated at the hematology ward before patients admitted to the ICU. Results: A total of 91 patients were enrolled in the study with a median (IQR) age of 55 (29) years. The median (IQR) NEWSS was 8 (3). Independent risk factors for ICU mortality were requirement of renal replacement therapy (P= 0.008), high Sequential Organ Failure Assessment (SOFA) score (P=0.002), development of Acute Respiratory Distress Syndrome (ARDS) (P=0.005). ICU mortality rate was 62%. Conclusion: Requirement of renal replacement therapy, high SOFA score and development of ARDS were important risk factors for ICU mortality in HM patients. The NEWSS was not found as a risk factor for ICU mortality in HM patients.

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ICU, hospital and one year mortality of patients suffering from solid or haematological malignancies

Abstract: The number of failing organs rather than malignancy itself drives outcome even in patients with malignancies. Thus the number of organs in failure rather than diagnosis should guide intensive care unit management in patients with malignancies.

Cited by 10 publications

References 33 publications

One-Year Mortality of Cancer Patients with an Unplanned ICU Admission: A Cohort Analysis Between 2008 and 2017 in the Netherlands

One-Year Mortality of Cancer Patients with an Unplanned ICU Admission: A Cohort Analysis Between 2008 and 2017 in the Netherlands

Hospital-acquired infections at an oncological intensive care cancer unit: differences between solid and hematological cancer patients

Evaluation of National Early Warning System for Mortality in Hematological Malignancy Patients Admitted to Intensive Care Unit: Prospective, Single Center, Observational Study

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