Oncological patients admitted to an intensive care unit. Analysis of predictors of in-hospital mortality

Díaz-Díaz, D.; Martínez, M.; Herrejón, E. Palencia

doi:10.1016/j.medine.2018.05.010

Cited by 9 publications

(15 citation statements)

References 30 publications

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“…Some studies have found the ECOG performance status ≥2 to be an indicator of poor hospital outcomes. 9 , 15 , 18 However, we recorded ECOG status at hospital admission and not at the time of ICU admission and this may have been the reason why we did not find ECOG performance status to be a predictor of mortality. However, Xia and Wang 12 recorded Karnofsky performance scale at the time of hospital and ICU admission but found that it did not influence the short-term mortality.…”

Section: Discussionmentioning

confidence: 90%

“…SOFA score has been shown to be an independent predictor of hospital mortality in many other studies. 16 , 18 Worsening SOFA score over consecutive days has also been shown to be an independent predictor of mortality in this subset of patients; 12 however, we recorded SOFA score only on the admission day. A variety of severity of illness scores [acute physiology and chronic health evaluation (APACHE) II, SAPS II, SAPS III] have been used in evaluating outcomes in similar group of patients, and APACHE II and SAPS III have been found to be independent predictors of mortality.…”

Section: Discussionmentioning

confidence: 97%

“…This is in contrast to other studies, which had relatively higher proportion (33–76%) of such patients. 10 , 11 , 17 , 18 To the best of our knowledge, only two studies from Asia 9 , 12 have reported outcomes in this subset of patients. However, these reports did not record whether the presence of distant metastasis was a predictor of mortality or not.…”

Section: Discussionmentioning

confidence: 99%

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Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study

Divatia¹,

Chaudhari²,

Dhundi³

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Objectives Critically ill solid organ malignancy patients admitted to intensive care unit (ICU) as unplanned medical admissions behave differently from other subsets of cancer patients (hematolymphoid malignancies and cancer patients admitted for postoperative care). These patients if appropriately selected may benefit from the ICU care. There is paucity of data on critically ill unplanned admissions of solid organ malignancies from South Asia. We analyzed data of patients with solid tumors with unplanned admissions to the ICU to determine the clinical, epidemiological characteristics, and predictors of hospital mortality in an Indian ICU. Materials and methods This prospective, observational study was done in our 14-bedded mixed medical–surgical ICU from July 2014 to November 2015. We included all consecutive adult unplanned admissions with solid organ malignancies having ICU stay of >24 hours. Surgical admissions, hematolymphoid malignancies, advanced malignancy with no treatment options, and those cured of cancer >5 years were excluded. Results Two hundred and thirty-five consecutive patients were included in this cohort. ICU and hospital mortalities were 36.6 and 40%, respectively. On multivariate analysis, cancer status [odds ratio (OR): 3.204; 95% confidence interval (CI): 1.271–8.078], invasive mechanical ventilation (OR: 5.940; 95% CI: 2.632–13.408), and sequential organ failure assessment (SOFA) score on the day of ICU admission (OR: 1.199; 95% CI: 1.042–1.379) were independent predictors of hospital mortality. Conclusion Acute respiratory failure and septic shock are the common reasons of unplanned ICU admission for patients with solid organ malignancies. With good patient selection, more than half of such patients are likely to be discharged alive from the hospital. How to cite this article Siddiqui SS, Narkhede AM, Chaudhari HK, Ravisankar NP, Dhundi U, Sarode S, et al. Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study. Indian J Crit Care Med 2021;25(12):1421–1426.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study

Divatia¹,

Chaudhari²,

Dhundi³

et al. 2021

Indian Journal of Critical Care Medicine

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“…15 Several studies have looked at the outcomes of cancer patients hospitalized in an intensive care unit (ICU) and requiring RRT (Table 1). 2–14 In a multicenter French study, Darmon et al included 1009 patients with hematological malignancies admitted to an ICU. 2 Overall 67% of the critically ill patients developed any stage of AKI (compared to 30–40% in the general ICU population), half of which were severe (according to the AKIN classification), 27% needed RRT.…”

Section: Aki In Cancer Patientsmentioning

confidence: 99%

How to use dialysis wisely in cancer patients?

Veen

Vusser

Moor

et al. 2020

Journal of Onco-Nephrology

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Both acute kidney injury (AKI) and chronic kidney disease (CKD) are common in cancer patients and are associated with inferior outcome, higher mortality rates, longer hospital stays and higher costs. In the aging population, the prevalence of both cancer and end-stage renal disease increase and practitioners are faced with difficult decisions regarding initiation of anticancer therapy and renal replacement therapy (RRT). Recent studies have shown no survival benefit of RRT ⩾80 years or even ⩾70 years in combination with severe comorbidities. However cancer itself does not seem to be a determining factor for short-term survival outcome and should not be used as argument alone to withhold RRT. Several prognostic tools can be implemented to identify elderly patients at high risk of functional decline and mortality after initiation of RRT. Advanced care planning focusses on timely discussions between patients, family members and practitioners about the patient’s desires and treatment goals which can help them avoid decisional conflict at the end-of-life and improve the quality of life.

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“…Several studies have clearly demonstrated that prognosis in cancer patients admitted to ICU because of acute, intermittent, and potentially reversible conditions is not necessarily worse than that in other patient groups (3)(4)(5). Several other "classical" ICU patient groups, such as those with congestive heart failure, cirrhosis of the liver, or decompensated chronic obstructive pulmonary disease, have a much worse ICU life expectancy than many cancer patients (6)(7)(8).…”

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confidence: 99%

Association of Acute Kidney Injury Receiving Kidney Replacement Therapy With Prognosis of Critically Ill Patients With and Without Cancer: A Retrospective Study

Druml

Zajic

Schellongowski

et al. 2021

Critical Care Medicine

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To assess outcomes of cancer patients receiving kidney replacement therapy due to acute kidney injury in ICUs and compare these with other patient groups receiving kidney replacement therapy in ICUs.DESIGN: Retrospective registry analysis. SETTING:Prospectively collected database of 296,424 ICU patients. PATIENTS:Patients with and without solid cancer with acute kidney injury necessitating kidney replacement therapy were identified and compared with those without acute kidney injury necessitating kidney replacement therapy. INTERVENTIONS:Descriptive statistics were used to ascertain prevalence of acute kidney injury necessitating kidney replacement therapy and solid cancer in ICU patients. Association of acute kidney injury necessitating kidney replacement therapy and cancer with prognosis was assessed using logistic regression analysis. To compare the attributable mortality of acute kidney injury necessitating kidney replacement therapy, 20,154 noncancer patients and 2,411 cancer patients without acute kidney injury necessitating kidney replacement therapy were matched with 12,827 noncancer patients and 1,079 cancer patients with acute kidney injury necessitating kidney replacement therapy. MEASUREMENTS AND MAIN RESULTS:Thirty-five thousand three hundred fifty-six ICU patients (11.9%) had solid cancer. Acute kidney injury necessitating kidney replacement therapy was present in 1,408 (4.0%) cancer patients and 13,637 (5.2%) noncancer patients. Crude ICU and hospital mortality was higher in the cancer group (646 [45.9%] vs 4,674 [34.3%], p < 0.001, and 787 [55.9%] vs 5,935 [43.5%], p < 0.001). In multivariable logistic regression analyses, odds ratio (95% CI) for hospital mortality was 1.73 (1.62-1.85) for cancer compared with no cancer 3.57 (3.32-3.83) for acute kidney injury necessitating kidney replacement therapy and 1.07 (0.86-1.33) for their interaction. In the matched subcohort, attributable hospital mortality of acute kidney injury necessitating kidney replacement therapy was 56.7% in noncancer patients and 48.0% in cancer patients. CONCLUSIONS:Occurrence rate of acute kidney injury necessitating kidney replacement therapy and prognosis in ICU patients with solid cancer are comparable with other ICU patient groups. In cancer, acute kidney injury necessitating kidney replacement therapy is associated with higher crude hospital mortality. However, the specific attributable mortality conveyed by acute kidney injury necessitating kidney replacement therapy is actually lower in cancer patients than in noncancer patients. Diagnosis of cancer per se does not justify withholding kidney replacement therapy.

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Oncological patients admitted to an intensive care unit. Analysis of predictors of in-hospital mortality

Cited by 9 publications

References 30 publications

Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study

Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study

How to use dialysis wisely in cancer patients?

Association of Acute Kidney Injury Receiving Kidney Replacement Therapy With Prognosis of Critically Ill Patients With and Without Cancer: A Retrospective Study

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