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Intensive Care Medicine

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01-11-2007 | Brief Report

Outcomes and prognostic factors in patients with head and neck cancer and severe acute illnesses

Authors: Márcio Soares, Jorge I. F. Salluh, Luisa Toscano, Fernando L. Dias

Published in: Intensive Care Medicine | Issue 11/2007

Abstract

Objectives

To evaluate the outcomes of patients with head and neck cancer and severe acute illnesses, and to identify characteristics associated with hospital mortality.

Design

Cohort study.

Setting

Ten-bed medical–surgical oncologic intensive care unit (ICU).

Patients

Consecutive patients admitted to the ICU over a 68-month period.

Interventions

None.

Measurements and results

Demographic, clinical and cancer-related data were collected. Multivariate logistic regression analysis was performed to identify predictive factors of hospital mortality. One hundred and twenty-one patients aged 63.3 ± 14.7 years were enrolled in the study. The main sites of primary tumor were oral cavity (30%), larynx (25%), pharynx (14%) and thyroid (9%). The main reasons for ICU admission were sepsis (37%) and acute respiratory failure (20%). The mean SAPS II score was 49.6 ± 17.8 points, and during ICU stay 100 (83%) patients received mechanical ventilation, 70 (58%), vasopressors, and 12 (10%), dialysis. The ICU, hospital and 6-month mortality rates were 39%, 56% and 72%, respectively. A performance status ≥ 2 [odds ratio (OR) = 5.17 (95% confidence interval, CI = 1.84–14.53)], advanced cancer (TNM stage IV) [OR = 3.80 (95% CI = 1.28–11.28)], and the number of organ failures [OR=2.87 (95% CI=1.83–4.50)] were associated with increased mortality in multivariate analysis.

Conclusions

In conjunction with clinical judgment and taking into consideration the patient's preferences and values, the knowledge of these outcome predictors may be useful in helping physicians to identify patients who might benefit from the intensive care and to improve discussions on patients' prognosis.

Davies L, Welch HG (2006) Epidemiology of head and neck cancer in the United States. Otolaryngol Head Neck Surg 135:451–457PubMedCrossRef

Forastiere AA, Trotti A, Pfister DG, Grandis JR (2006)Head and neck cancer: recent advances and new standards of care. J Clin Oncol 24:2603–2605PubMedCrossRef

Downey RJ, Friedlander P, Groeger J, Kraus D, Schantz S, Spiro R, Strong E, Shaha A, Shah J (1999) Critical care for the severely ill head and neck patient. Crit Care Med 27:95–97PubMedCrossRef

To EW, Tsang WM, Lai EC, Chu MC (2002) Retrospective study on the need of intensive care unit admission after major head and neck surgery. A N Z J Surg 72:11–14CrossRef

de Melo GM, Ribeiro KC, Kowalski LP, Deheinzelin D (2001) Risk factors for postoperative complications in oral cancer and their prognostic implications. Arch Otolaryngol Head Neck Surg 127:828–833PubMed

Godden DR, Patel M, Baldwin A, Woodwards RT (1999) Need for intensive care after operations for head and neck cancer surgery. Br J Oral Maxillofac Surg 37:502–505PubMedCrossRef

Soares M, Salluh JI (2006) Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care. Intensive Care Med 32:1839–1844PubMedCrossRef

Le Gall J-R, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963PubMedCrossRef

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMed

10.

Piccirllo JF (2001) Adult Comorbidity Evaluation-27. Comorbidity data collection form. Available at: http://oto.wustl.edu/clinepi/Forms/com_form.doc. Assessed 28 September 2004

11.

Zubrod CG, Schneiderman M, Frei III E, Brindley C, Gold GL, Shnider B, Oviedo R, Gorman J, Jones R Jr, Jonsson U, Colsky J, Chalmers T, Ferguson B, Dederick M, Holland J, Selawry O, Regelson W, Lasagna L, Owens Jr AH (1960) Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. J Chron Dis 11:7–33CrossRef

12.

Soares M, Salluh JI, Ferreira CG, Luiz RR, Spector N, Rocco JR (2005) Impact of two different comorbidity measures on the six-month mortality of critically ill cancer patients. Intensive Care Med 31:408–415PubMedCrossRef

13.

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655PubMed

14.

Hosmer DW, Lemeshow S (2000) Applied logistic regression, 2nd edn. Wiley-Interscience, New York

15.

Hanley JA, McNeil BJ (1982) The meaning and use of the area under receiver operating characteristic (ROC) curve. Radiology 143:29–36PubMed

16.

Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall J-R, Schlemmer B (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 26:1817–1823PubMedCrossRef

17.

Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16:761–770PubMed

18.

Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 160:1957–1961PubMed

19.

Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328PubMedCrossRef

Title: Outcomes and prognostic factors in patients with head and neck cancer and severe acute illnesses
Authors: Márcio Soares
Jorge I. F. Salluh
Luisa Toscano
Fernando L. Dias
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 11/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0775-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Outcomes and prognostic factors in patients with head and neck cancer and severe acute illnesses

Abstract

Objectives

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

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