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2020-11-27
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- INI - Artigos de Periódicos [3646]
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CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH CANCER REQUIRING ADMISSION TO INTENSIVE CARE UNITS: A PROSPECTIVE MULTICENTER STUDY
Author
Soares, Márcio
Caruso, Pedro
Silva, Eliézer
Teles, José M. M.
Lobo, Suzana M. A.
Friedman, Gilberto
Dal Pizzol, Felipe
Mello, Patricia V. C.
Bozza, Fernando A.
Silva, Ulisses V. A.
Torelly, André P.
Knibel, Marcos F.
Rezende, Ederlon
Netto, José J.
Piras, Claudio
Castro, Aline
Ferreira, Bruno S.
Réa-Neto, Álvaro
Olmedo, Patrícia B.
Salluh, Jorge I. F.
The Brazilian Research in Intensive Care Network (BRICNet)
Caruso, Pedro
Silva, Eliézer
Teles, José M. M.
Lobo, Suzana M. A.
Friedman, Gilberto
Dal Pizzol, Felipe
Mello, Patricia V. C.
Bozza, Fernando A.
Silva, Ulisses V. A.
Torelly, André P.
Knibel, Marcos F.
Rezende, Ederlon
Netto, José J.
Piras, Claudio
Castro, Aline
Ferreira, Bruno S.
Réa-Neto, Álvaro
Olmedo, Patrícia B.
Salluh, Jorge I. F.
The Brazilian Research in Intensive Care Network (BRICNet)
Affilliation
Instituto Nacional de Câncer. Hospital de Câncer. ICU. Rio de Janeiro, RJ, Brazil.
Hospital A. C. Camargo. ICU. São Paulo, SP, Brazil.
Hospital Israelita Albert Einstein. ICU. São Paulo, SP, Brazil.
Hospital Português. ICU. Salvador, BA, Brazil.
Medical School. Department of Internal Medicine. Division of Critical Care Medicine. São José do Rio Preto, SP, Brazil. / Hospital de Base. São José do Rio Preto, SP, Brazil.
Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil / Santa Casa de Misericórdia de Porto Alegre. ICU. Porto Alegre, RS, Brazil.
Universidade do Extremo Sul Catarinense. Unidade Acadêmica de Ciências da Saúde. Laboratório de Fisiopatologia Experimental. Programa de Pós-Graduação Ciências da Saúde. Criciúma, SC, Brasil.
Universidade Estadual do Piauí. ICU. Teresina, PI, Brazil.
Fundação Oswaldo Cruz. Instituto de Pesquisas Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Pio XII. Hospital do Câncer de Barretos. Barretos, SP, Brasil.
Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil / Santa Casa de Misericórdia de Porto Alegre. ICU. Porto Alegre, RS, Brazil.
Hospital São Lucas. Rio de Janeiro, RJ, Brasil.
Hospital do Servidor Público Estadual. São Paulo, SP, Brazil.
Instituto Nacional de Câncer. Hospital do Câncer II. ICU. Rio de Janeiro, RJ, Brazil.
Vitória Apart Hospital. ICU. Vitória, ES, Brazil
Hospital Samaritano. ICU. Rio de Janeiro, RJ, Brazil.
Hospital Pasteur. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Paraná. Hospital de Clínicas. ICU. Curitiba, PR, Brazil.
Instituto Nacional de Câncer. Hospital de Câncer. ICU. Rio de Janeiro, RJ, Brazil.
Instituto Nacional de Câncer. Hospital de Câncer. ICU. Rio de Janeiro, RJ, Brazil.
Hospital A. C. Camargo. ICU. São Paulo, SP, Brazil.
Hospital Israelita Albert Einstein. ICU. São Paulo, SP, Brazil.
Hospital Português. ICU. Salvador, BA, Brazil.
Medical School. Department of Internal Medicine. Division of Critical Care Medicine. São José do Rio Preto, SP, Brazil. / Hospital de Base. São José do Rio Preto, SP, Brazil.
Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil / Santa Casa de Misericórdia de Porto Alegre. ICU. Porto Alegre, RS, Brazil.
Universidade do Extremo Sul Catarinense. Unidade Acadêmica de Ciências da Saúde. Laboratório de Fisiopatologia Experimental. Programa de Pós-Graduação Ciências da Saúde. Criciúma, SC, Brasil.
Universidade Estadual do Piauí. ICU. Teresina, PI, Brazil.
Fundação Oswaldo Cruz. Instituto de Pesquisas Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Pio XII. Hospital do Câncer de Barretos. Barretos, SP, Brasil.
Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brazil / Santa Casa de Misericórdia de Porto Alegre. ICU. Porto Alegre, RS, Brazil.
Hospital São Lucas. Rio de Janeiro, RJ, Brasil.
Hospital do Servidor Público Estadual. São Paulo, SP, Brazil.
Instituto Nacional de Câncer. Hospital do Câncer II. ICU. Rio de Janeiro, RJ, Brazil.
Vitória Apart Hospital. ICU. Vitória, ES, Brazil
Hospital Samaritano. ICU. Rio de Janeiro, RJ, Brazil.
Hospital Pasteur. Rio de Janeiro, RJ, Brasil.
Universidade Federal do Paraná. Hospital de Clínicas. ICU. Curitiba, PR, Brazil.
Instituto Nacional de Câncer. Hospital de Câncer. ICU. Rio de Janeiro, RJ, Brazil.
Instituto Nacional de Câncer. Hospital de Câncer. ICU. Rio de Janeiro, RJ, Brazil.
Abstract
Objective: To evaluate the characteristics and outcomes of patients with cancer admitted to several intensive care units. Knowledge on patients with cancer requiring intensive care is mostly restricted to single-center studies. Design: Prospective, multicenter, cohort study. Setting: Intensive care units from 28 hospitals in Brazil.
Patients: A total of 717 consecutive patients included over a 2-mo period. Interventions: None. Measurements and Main Results: There were 667 (93%) patients with solid tumors and 50 (7%) patients had hematologic
malignancies. The main reasons for intensive care unit admission were postoperative care (57%), sepsis (15%), and respiratory failure (10%). Overall hospital mortality rate was 30% and was higher in patients admitted because of medical complications (58%) than in emergency (37%) and scheduled (11%) surgical
patients (p < .001). Adjusting for covariates other than the type of admission, the number of hospital days before intensive care unit admission (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01–1.37), higher Sequential Organ Failure Assessment scores (OR, 1.25; 95% CI, 1.17–1.34), poor performance status (OR, 3.40; 95% CI, 2.19 –5.26), the need for mechanical ventilation (OR, 2.42; 95% CI, 1.51–3.87), and active underlying malignancy in recurrence or progression (OR, 2.42; 95% CI, 1.51–3.87) were associated with increased hospital mortality in multivariate analysis. Conclusions: This large multicenter study reports encouraging survival rates for patients with cancer requiring intensive care. In these patients, mortality was mostly dependent on the severity of organ failures, performance status, and need for mechanical ventilation rather than cancer-related characteristics, such as the type of malignancy or the presence of neutropenia.
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