Short‐ and long‐term outcomes of neutropenic cancer patients in intensive care according to requirement for invasive ventilation

Abstract

Background: Neutropenic fever is a frequently encountered complication when caring for cancer patients and can lead to intensive care admission, with high mortality rates in those patients who require invasive mechanical ventilation (IMV). Although hospital survival in this population has improved, long-term outcomes of critically ill neutropenic cancer patients have not been well defined.Aims: To evaluate short-and long-term outcomes of neutropenic cancer patients admitted to intensive care, according to requirement for invasive ventilation. Additionally, we aimed to determine predictors of poor clinical outcomes in this group.Methods: A retrospective cohort study of neutropenic cancer patients admitted to our intensive care unit (ICU) from 2008 to 2016. Results:We included 192 cancer patients of whom 100 (52.1%) required IMV. Overall ICU mortality was 29.7% and 12-month post-ICU mortality was 61.5%. Patients requiring IMV had significantly higher short-and long-term mortality (P < 0.001). Multivariate analysis determined three variables to be predictors of mortality at ICU discharge in the whole cohort: IMV (OR 13.52), renal replacement therapy (RRT, OR 2.37) and higher APACHE II scores (OR 1.1 for each unit increase). These variables were identical in the subgroup requiring invasive ventilation, with RRT (OR 2.76) and APACHE II scores (OR 1.1 for each unit increase) predicting short-term mortality.Conclusion: Neutropenic cancer patients admitted to ICU have lower short-term mortality than previously reported in cohort studies, however their mortality rises significantly following discharge from ICU. Those patients who require IMV are at significantly increased risk of both short-and long-term mortality.

Outcome of Cancer Patients with an Unplanned Intensive Care Unit Admission: Predictors of Mortality and Long-term Survival

“…The presence of febrile neutropenia in cancer patients admitted to ICU is associated with increased morbidity and mortality,[ 31 ] especially if they require invasive ventilation. [ 32 33 ] Although there were more cases with febrile neutropenia in our study in the HM group (35%) compared with the NHM group (14%), febrile neutropenia was a predictor of mortality in NHM (OR = 2.34) but not in HM (OR = 0.79).…”

Temporal trend of tracheostomy in patients hospitalized in the Brazilian National Unified Health System from 2011 to 2020

“…One of these changes can be observed in the significant reduction, 20.74%, in the average number of tracheostomies performed in patients hospitalized by Chapter II of the ICD (cancer patients) conditions in relation to previous years, which can be explained by the obstacles to accessing the health system occurred since the beginning of the COVID-19 pandemic. With the system overloaded by the occupation of beds, the lack of professionals, and the shortage of medicines 26 , there was a delay in cancer screenings and treatments in the last year studied 27 , 28 . Allied to this scenario, due to their own condition or the effect of the drugs in use, cancer patients became a risk group for severe COVID due to low immunity, which raised the requirements for the indication of hospital admissions in this population.…”