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OUTCOMES IN CRITICALLY ILL PATIENTS WITH CANCER-RELATED COMPLICATIONS
Author
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Federal University of Rio de Janeiro. School of Medicin. Postgraduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. School of Medicin. Postgraduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil.
Fundação Pio XII. Hospital do Câncer de Barretos. ICU. Barretos, SP, Brasil.
A.C. Camargo Cancer Center. ICU. São Paulo, SP, Brazil.
Irmandade da Santa Casa de Misericórdia de Porto Alegre. Rede Institucional de Pesquisa e Inovação em Medicina Intensiva. Porto Alegre, RS, Brasil.
Hospital Israelita Albert Einstein. ICU. São Paulo, SP, Brasil.
Hospital Português. ICU. Salvador, BA, Brasil.
Hospital São Lucas. Rio de Janeiro, RJ, Brasil.
Hospital do Servidor Público Estadual. ICU. São Paulo, SP, Brasil.
Instituto Nacional de Câncer, Hospital do Câncer II. ICU. Rio de Janeiro, RJ, Brasil.
Vitória Apart Hospital. ICU. Vitória, ES, Brasil.
Sírio-Libanês Hospital. Research and Education Institute. São Paulo, SP, Brazil.
D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Federal University of Rio de Janeiro. School of Medicin. Postgraduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. School of Medicin. Postgraduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil / D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / National Cancer Institute. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. School of Medicin. Postgraduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil / D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / National Cancer Institute. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. School of Medicin. Postgraduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil.
Fundação Pio XII. Hospital do Câncer de Barretos. ICU. Barretos, SP, Brasil.
A.C. Camargo Cancer Center. ICU. São Paulo, SP, Brazil.
Irmandade da Santa Casa de Misericórdia de Porto Alegre. Rede Institucional de Pesquisa e Inovação em Medicina Intensiva. Porto Alegre, RS, Brasil.
Hospital Israelita Albert Einstein. ICU. São Paulo, SP, Brasil.
Hospital Português. ICU. Salvador, BA, Brasil.
Hospital São Lucas. Rio de Janeiro, RJ, Brasil.
Hospital do Servidor Público Estadual. ICU. São Paulo, SP, Brasil.
Instituto Nacional de Câncer, Hospital do Câncer II. ICU. Rio de Janeiro, RJ, Brasil.
Vitória Apart Hospital. ICU. Vitória, ES, Brasil.
Sírio-Libanês Hospital. Research and Education Institute. São Paulo, SP, Brazil.
D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Federal University of Rio de Janeiro. School of Medicin. Postgraduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. School of Medicin. Postgraduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil / D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / National Cancer Institute. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. School of Medicin. Postgraduate Program in Internal Medicine. Rio de Janeiro, RJ, Brazil / D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / National Cancer Institute. Postgraduate Program. Rio de Janeiro, RJ, Brazil.
Abstract
Introduction: Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients. Materials and Methods: Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality. Results: Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS 2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P<0.001 for all analyses). ICU (47% vs. 27%) and hospital (63% vs. 38%) mortality rates were also higher in patients with cancer-related complications (P<0.001). Chemo/radiation therapyinduced toxicity (6%), venous thromboembolism (5%), respiratory failure (4%), gastrointestinal involvement (3%) and vena cava syndrome (VCS) (2%) were the most frequent cancer-related complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality [odds ratio (OR) = 1.25 (95% confidence interval, 0.94–1.66), P = 0.131]. However, among the individual cancer-related complications, VCS [OR = 3.79 (1.11–12.92), P = 0.033], gastrointestinal involvement [OR = 3.05 (1.57–5.91), P = <0.001] and respiratory failure [OR = 1.96(1.04–3.71), P = 0.038] were independently associated with in-hospital mortality. Conclusions: The prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of an acute cancer-related complication per se should not guide decisions to admit a patient to ICU.
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