| Author | Zampieri, Fernando G. | |
| Author | Romano, Thiago G. | |
| Author | Salluh, Jorge I. F. | |
| Author | Taniguchi, Leandro U. | |
| Author | Mendes, Pedro V. | |
| Author | Nassar Jr., Antonio P. | |
| Author | Costa, Roberto | |
| Author | Viana, William N. | |
| Author | Maia, Marcelo O. | |
| Author | Lima, Mariza F. A. | |
| Author | Cappi, Sylas B. | |
| Author | Carvalho, Alexandre G. R. | |
| Author | Marco, Fernando V. C. de | |
| Author | Santino, Marcelo S. | |
| Author | Perecmanis, Eric | |
| Author | Miranda, Fabio G. | |
| Author | Ramos, Grazielle V. | |
| Author | Silva, Aline R. | |
| Author | Hoff, Paulo M. | |
| Author | Bozza, Fernando A. | |
| Author | Soares, Marcio | |
| Access date | 2021-07-28T19:52:58Z | |
| Available date | 2021-07-28T19:52:58Z | |
| Document date | 2021 | |
| 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 | pt_BR |
| ISSN | 0342-4642 | pt_BR |
| URI | https://www.arca.fiocruz.br/handle/icict/48393 | |
| Language | eng | pt_BR |
| Publisher | Springer | pt_BR |
| Rights | restricted access | pt_BR |
| Title | Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study | pt_BR |
| Type | Article | |
| DOI | 10.1007/s00134-020-06184-2 | |
| 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. | pt_BR |
| 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. | pt_BR |
| Affilliation | 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. | pt_BR |
| Affilliation | D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil. | pt_BR |
| Affilliation | Hospital Sírio-Libanês. Research and Education Institute. São Paulo, SP, Brazil / University of São Paulo. Emergency Medicine Discipline. São Paulo, SP, Brazil. | pt_BR |
| Affilliation | 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. | pt_BR |
| Affilliation | A.C. Camargo Cancer Center. Intensive Care Unit. São Paulo, SP, Brazil. | pt_BR |
| Affilliation | Hospital Quinta D'Or. Intensive Care Unit. Rio de Janeiro, RJ, Brazil. | pt_BR |
| Affilliation | Hospital Copa D'Or. Intensive Care Unit. Rio de Janeiro, RJ, Brazil. | pt_BR |
| Affilliation | 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. | pt_BR |
| Affilliation | Hospital Esperança Recife. Intensive Care Unit. Recife, PE, Brazil. | pt_BR |
| Affilliation | Hospital São Luiz. Unidade Brasil. Intensive Care Unit. Santo André, SP, Brazil. | pt_BR |
| Affilliation | UDI Hospital. Intensive Care Unit. São Luís, MA, Brazil. | pt_BR |
| Affilliation | Hospital ViValle. Intensive Care Unit. São José dos Campos, SP, Brazil. | pt_BR |
| Affilliation | Hospital Barra D'Or. Intensive Care Unit. Rio de Janeiro, RJ, Brazil. | pt_BR |
| Affilliation | Hospital Caxias D'Or. Intensive Care Unit. Duque de Caxias, RJ, Brazil. | pt_BR |
| Affilliation | Hospital Copa Star. Intensive Care Unit. Rio de Janeiro, RJ, Brazil. | pt_BR |
| Affilliation | D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil. | pt_BR |
| Affilliation | D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil. | pt_BR |
| Affilliation | D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil. / Oncologia D'Or. São Paulo, SP, Brazil. | pt_BR |
| Affilliation | 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. | pt_BR |
| Affilliation | D'Or Institute for Research and Education. Department of Critical Care and Graduate Program in Translational Medicine. Rio de Janeiro, RJ, Brazil. | pt_BR |
| Subject | Bayesian analysis | pt_BR |
| Subject | Cancer | pt_BR |
| Subject | Critical care | pt_BR |
| Subject | Mortality trends | pt_BR |
| Subject | Multicenter study | pt_BR |
