Rate and patterns of ICU admission among colorectal cancer patients: a single-center experience

Abstract

Purpose The purposes of this study were to evaluate, in colorectal cancer patients, the cause of ICU admission and to find predictors of death during and after hospitalization. Methods This is a retrospective study including all patients with colorectal cancer admitted in the ICU of a cancer hospital from January 1st 2003 to December 31 2012. Results Among 3721 ICU admissions occurring during the study period, 119 (3.2 %) admissions dealt with colorectal cancer, of whom 89 were eligible and assessable. The main reasons for admission were of metabolic (24 %), hemodynamic (19 %), cardiovascular (18 %), gastrointestinal (16 %), respiratory (13 %), or neurologic (6 %) origin. These complications were due to cancer in 43 %, to the antineoplastic treatment in 25 %, or were unrelated to the cancer or its treatment in 33 %. A quarter of the patients died during hospitalization. Independent predictors of death were the Sequential Organ Failure Assessment (SOFA) score (with risk of dying increasing by 42 % per unit of SOFA score), fever (with risk of dying multiplied by three per°C), and high values of GOT (with risk of dying multiplied by 1 % per unit increase), while cancer control (i.e., stage progression or not), compliance to the initial cancer treatment plan, and LDH ≤ median levels had prognostic significance for further longer survival after hospital discharge. Conclusion This is the first study looking at specific causes for unplanned ICU admission of patients with colorectal cancer. Hospital mortality was influenced by the characteristics of the complication that entailed the ICU admission while cancer characteristics retained their prognostic influence on survival after hospital discharge.

Are Intensive Cares Worthwhile for Breast Cancer Patients: The Experience of an Oncological ICU

“…As the literature is scarce concerning the prognostic value of GOT/GPT in cancer patients admitted into ICU, we postulate that an increase in liver enzymes occurred in the context of multiple organ failure, secondary to the acute complication but can also be, in a limited number of patients, due to liver dysfunction in the context of metastasis in the liver, yet already present beforehand for some people. This relationship had already been observed in a previous study on colorectal cancer from our group (13). …”

“…We decided to not include them in the predictive and prognostic factors analyses because we only considered variables available at ICU admission except for gravity scores. In various publications, the prognosis in ICU and hospital stay of cancer patients is mainly influenced by the physiological disturbances caused by the complications leading to ICU admission (11–13). For breast cancer in particular, a relationship between hospital mortality and APACHE II score was reported (5) despite limited sensitivity (54%) for hospital mortality.…”

Sepsis and Septic Shock Definitions in Patients With Cancer Admitted in ICU

“…We show that the increase in intrahospital mortality is correlated with an increasing SOFA and qSOFA scores. As already shown in the previous series, [19][20][21][22] prognostic is dependent mainly on the acute pathophysiological changes related to the acute complication that was responsible for ICU admission. Intrahospital mortality of patients being in complete remission (21%) is lower than that in other groups from our series and is comparable to the general population (24.2%).…”

In-hospital and day-120 survival of critically ill solid cancer patients after discharge of the intensive care units: results of a retrospective multicenter study—A Groupe de recherche respiratoire en réanimation en Onco–Hématologie (Grrr-OH) study

“…The influence of ICU stay on the nature of subsequent antineoplastic therapy was evaluated in three studies, with change rates between 31 and 34% in relation to the project defined before the stay in the ICU [20, 23, 24].…”