Changes in critically ill cancer patients’ short-term outcome over the last decades: results of systematic review with meta-analysis on individual data

Darmon, Michaël; Bourmaud, Aurélie; Georges, Quentin; Soares, Márcio; Jeon, Kyeongman; Oeyen, Sandra; Rhee, Chin Kook; Gruber, Pascale; Ostermann, Marlies; Hill, Quentin A.; Depuydt, Pieter; Ferrà, Christelle; Toffart, Anne‐Claire; Schellongowski, Peter; Müller, Alice Mânica; Lemiale, Virginie; Mokart, Djamel; Azoulay, Élie

doi:10.1007/s00134-019-05653-7

Cited by 114 publications

(106 citation statements)

References 66 publications

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“…The hospital mortality of our study population was similar to other European literature (44%) (3)(4)(5)(24)(25)(26)(27). In contrast, the long-term mortality in our study was higher than in other studies (28)(29)(30)(31)(32)(33)(34).…”

Section: Discussionsupporting

confidence: 85%

“…Moreover, the ICU and hospital mortality of patients with an active malignancy has decreased signi cantly (1,3,5). Patients with a solid malignancy show a similar mortality rate compared to critically ill patients admitted to the ICU without a malignancy (6).…”

mentioning

confidence: 99%

“…Patients with a solid malignancy show a similar mortality rate compared to critically ill patients admitted to the ICU without a malignancy (6). While literature regarding the mortality of critically ill patients with a hematological malignancy is heterogeneous (7)(8)(9), a decrease in mortality over the years has been described (5,10).…”

mentioning

confidence: 99%

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Factors predicting short-term and long-term mortality in ICU patients with a malignancy: the importance of SOFA and ECOG performance status

Zee¹,

Noordhuis²,

Epker³

et al. 2020

Preprint

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Background Intensive Care Unit (ICU) triage decisions in patients with a malignancy can be difficult as clinicians have concerns about potential unfavourable outcomes. Therefore, clinicians may have doubts about the appropriateness of an ICU admission. The aim of this study was to assess the long-term mortality and performance status of critically ill patients with an active malignancy or a malignancy in their prior history admitted unplanned to the ICU. Furthermore, we aimed to compare the long-term mortality of those patients to the mortality of patients without a malignancy. Methods We conducted a retrospective cohort study in a large tertiary referral university hospital in the Netherlands. We categorized all adult patients with an unplanned admission to the ICU in 2017 in two groups: 1) the study population consisting of patients with an active malignancy and patients with a malignancy in their medical history (complete remission, CR) and 2) patients without a malignancy. Pearson’s Chi-square tests and Independent Samples T-Tests or the Mann-Whitney U tests were used to evaluate the long-term mortality, the primary objective was 2-year mortality. Results Of the 1046 unplanned ICU admissions, 125 (12%) patients had an active malignancy, 41 (3.9%) < 5 year CR and 33 (3.2%) ≥ 5 year CR. The 2-year mortality in the study population was significantly higher than in the population without a malignancy (67.4% and 40.2%, P < 0.001). The median performance status at 2 years after ICU admission in the study population was 1 (IQR 0–2). SOFA score (OR 1.25; 95% CI 1.10–1.42) and ECOG performance status of 2 (OR 11.23; 95% CI 2.66–47.33), 3 (OR 5.91; 95% CI 1.77–19.79) and 4 (OR 13.16; 1.85–93.74) were independently associated with 2-year mortality. Conclusions Two thirds of the study population died within 2 years after ICU admission, which is higher than in the population without a malignancy. However, the majority of the study population had a good performance status at 2 years after ICU admission. The severity of the critical illness and the performance status before ICU admission are independently associated with 2-year mortality and should be considered as main factors in ICU triage.

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Section: Discussionsupporting

confidence: 85%

mentioning

confidence: 99%

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Factors predicting short-term and long-term mortality in ICU patients with a malignancy: the importance of SOFA and ECOG performance status

Zee¹,

Noordhuis²,

Epker³

et al. 2020

Preprint

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“…16,17 Mortality rates for critically ill patients with cancer requiring mechanical ventilation have decreased over the last 2 decades to 63%. 18 Thus, our increase may represent a finding unique to patients with cancer and possibly specific to patients with gynecologic cancer and a COVID-19 infection. Nonetheless, patients with gynecologic cancer who are hospitalized for COVID-19 can be counseled that almost 75% will recover and be discharged.…”

Section: Discussionmentioning

confidence: 87%

COVID‐19 outcomes of patients with gynecologic cancer in New York City

Lara

O’Cearbhaill

Smith

et al. 2020

Cancer

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Background New York City (NYC) is the epicenter of severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID‐19]) in the United States. Clinical characteristics and outcomes of vulnerable populations, such as those with gynecologic cancer who develop COVID‐19 infections, is limited. Methods Patients from 6 NYC‐area hospital systems with known gynecologic cancer and a COVID‐19 diagnosis were identified. Demographic and clinical outcome data were abstracted through a review of electronic medical records. Results Records for 121 patients with gynecologic cancer and COVID‐19 were abstracted; the median age at the COVID‐19 diagnosis was 64.0 years (interquartile range, 51.0‐73.0 years). Sixty‐six of the 121 patients (54.5%) required hospitalization; among the hospitalized patients, 45 (68.2%) required respiratory intervention, 20 (30.3%) were admitted to the intensive care unit, and 9 (13.6%) underwent invasive mechanical ventilation. Seventeen patients (14.0%) died of COVID‐19 complications. No patient requiring mechanical ventilation survived. On multivariable analysis, hospitalization was associated with an age ≥64 years (risk ratio [RR], 1.73; 95% confidence interval [CI], 1.18‐2.51), African American race (RR, 1.56; 95% CI, 1.13‐2.15), and 3 or more comorbidities (RR, 1.43; 95% CI, 1.03‐1.98). Only recent immunotherapy use (RR, 3.49; 95% CI, 1.08‐11.27) was associated with death due to COVID‐19 on multivariable analysis; chemotherapy treatment and recent major surgery were not predictive of COVID‐19 severity or mortality. Conclusions The case fatality rate among gynecologic oncology patients with a COVID‐19 infection is 14.0%. Recent immunotherapy use is associated with an increased risk of mortality related to COVID‐19 infection. Lay Summary The case fatality rate among gynecologic oncology patients with a coronavirus disease 2019 (COVID‐19) infection is 14.0%; there is no association between cytotoxic chemotherapy and cancer‐directed surgery and COVID‐19 severity or death. As such, patients can be counseled regarding the safety of continued anticancer treatments during the pandemic. This is important because the ability to continue cancer therapies for cancer control and cure is critical.

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“…42 (45%) and 48 (51%) patients required cardiovascular and ventilatory support during their stay in ICU, respectively. On admission to ICU, the median SOFA score was 8 [IQR 6-10], the median APACHE II score was 20 [IQR [16][17][18][19][20][21][22][23][24], and 82% of patients had sepsis. ICU and 28-day mortality were 33% and 48%, respectively.…”

Section: Haematological Malignanciesmentioning

confidence: 99%

Acute kidney injury in critically ill cancer patients is associated with mortality: A retrospective analysis

et al. 2020

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Background In critically ill patients, acute kidney injury (AKI) is common and associated with short-and long-term complications. Our objectives were to describe the epidemiology and impact of AKI in cancer patients admitted to the Intensive Care Unit (ICU). Methods We identified all patients with a haematological malignancy (HM) or solid tumour (ST) who had an emergency admission to the ICU in a tertiary care centre between January 2004 and July 2012. AKI was defined according to the KDIGO criteria. Results 429 patients were included of whom 259 (60%) had AKI. Among HM patients, 73 (78%) had AKI (70% AKI on admission to ICU; 7% during ICU stay); among ST patients, 186 (56%) had AKI (45% on admission to ICU, 11% during ICU stay). ICU and 28-day mortality rates were 33% and 48%, respectively in HM patients, and 22% and 31%, respectively in ST patients. Multivariable analysis showed that AKI was an independent risk factor for both ICU and 28-day mortality. New AKI after 24 hours in ICU was associated with higher mortality than AKI on admission. Conclusions AKI is common in critically ill cancer patients and independently associated with ICU and 28-day mortality.

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Changes in critically ill cancer patients’ short-term outcome over the last decades: results of systematic review with meta-analysis on individual data

Cited by 114 publications

References 66 publications

Factors predicting short-term and long-term mortality in ICU patients with a malignancy: the importance of SOFA and ECOG performance status

Factors predicting short-term and long-term mortality in ICU patients with a malignancy: the importance of SOFA and ECOG performance status

COVID‐19 outcomes of patients with gynecologic cancer in New York City

Acute kidney injury in critically ill cancer patients is associated with mortality: A retrospective analysis

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