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TRENDS IN CLINICAL PROFILES, ORGAN SUPPORT USE AND OUTCOMES OF PATIENTS WITH CANCER REQUIRING UNPLANNED ICU ADMISSION: A MULTICENTER COHORT STUDY
Zampieri, Fernando G. et al. | Date Issued: 2021
Author
Zampieri, Fernando G.
Romano, Thiago G.
Salluh, Jorge I. F.
Taniguchi, Leandro U.
Mendes, Pedro V.
Nassar Jr., Antonio P.
Costa, Roberto
Viana, William N.
Maia, Marcelo O.
Lima, Mariza F. A.
Cappi, Sylas B.
Carvalho, Alexandre G. R.
Marco, Fernando V. C. de
Santino, Marcelo S.
Perecmanis, Eric
Miranda, Fabio G.
Ramos, Grazielle V.
Silva, Aline R.
Hoff, Paulo M.
Bozza, Fernando A.
Soares, Marcio
Affilliation
D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil. / HCor. Research Institute. São Paulo, SP, Brazil / Southern Denmark University. Center of Epidemiological and Clinical Research. Odense, Denmark.
Hospital Vila Nova Star. Intensive Care Unit. São Paulo, SP, Brazil / ABC Medical School. Nephrology Department. Santo André, SP, Brazil / Hospital São Luiz. Unidade Itaim. Oncological Intensive Care Unit. São Paulo, SP, Brazil.
D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.
Hospital Sírio-Libanês. Research and Education Institute. São Paulo, SP, Brazil / University of São Paulo. Emergency Medicine Discipline. São Paulo, SP, Brazil.
Hospital Vila Nova Star. Intensive Care Unit. São Paulo, SP, Brazil / University of São Paulo. Emergency Medicine Discipline. São Paulo, SP, Brazil / Hospital São Luiz. Unidade Itaim. Oncological Intensive Care Unit. São Paulo, SP, Brazil.
A.C. Camargo Cancer Center. Intensive Care Unit. São Paulo, SP, Brazil.
Hospital Quinta D'Or. Intensive Care Unit. Rio de Janeiro, RJ, Brazil.
Hospital Copa D'Or. Intensive Care Unit. Rio de Janeiro, RJ, Brazil.
Hospital Santa Luzia Rede D'Or São Luiz. Intensive Care Unit. Brasília, DF, Brazil / Hospital DF Star Rede D'Or São Luiz. Intensive Care Unit. Brasília, DF, Brazil.
Hospital Esperança Recife. Intensive Care Unit. Recife, PE, Brazil.
Hospital São Luiz. Unidade Brasil. Intensive Care Unit. Santo André, SP, Brazil.
UDI Hospital. Intensive Care Unit. São Luís, MA, Brazil.
Hospital ViValle. Intensive Care Unit. São José dos Campos, SP, Brazil.
Hospital Barra D'Or. Intensive Care Unit. Rio de Janeiro, RJ, Brazil.
Hospital Caxias D'Or. Intensive Care Unit. Duque de Caxias, RJ, Brazil.
Hospital Copa Star. Intensive Care Unit. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil. / Oncologia D'Or. São Paulo, SP, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil.
Abstract
Purpose: To describe trends in outcomes of cancer patients with unplanned admissions to intensive-care units (ICU) according to cancer type, organ support use, and performance status (PS) over an 8-year period. Methods: We retrospectively analyzed prospectively collected data from all cancer patients admitted to 92 medical-surgical ICUs from July/2011 to June/2019. We assessed trends in mortality through a Bayesian hierarchical model adjusted for relevant clinical confounders and whether there was a reduction in ICU length-of-stay (LOS) over time using a competing risk model. Results: 32,096 patients (8.7% of all ICU admissions; solid tumors, 90%; hematological malignancies, 10%) were studied. Bed/days use by cancer patients increased up to more than 30% during the period. Overall adjusted mortality decreased by 9.2% [95% credible interval (CI), 13.1-5.6%]. The largest reductions in mortality occurred in patients without need for organ support (9.6%) and in those with need for mechanical ventilation (MV) only (11%). Smallest reductions occurred in patients requiring MV, vasopressors, and dialysis (3.9%) simultaneously. Survival gains over time decreased as PS worsened. Lung cancer patients had the lowest decrease in mortality. Each year was associated with a lower sub-hazard for ICU death [SHR 0.93 (0.91-0.94)] and a higher chance of being discharged alive from the ICU earlier [SHR 1.01 (1-1.01)]. Conclusion: Outcomes in critically ill cancer patients improved in the past 8 years, with reductions in both mortality and ICU LOS, suggesting improvements in overall care. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised PS.
Keywords
Bayesian analysis
Cancer
Critical care
Mortality trends
Multicenter study
 
Publisher
Springer
Citation
ZAMPIERI, Fernando G. et al. Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study. Intensive care medicine, v. 47, n. 2, p. 170-179, 2021
DOI
10.1007/s00134-020-06184-2
ISSN
0342-4642