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Intensive Care Medicine
Published in: Intensive Care Medicine 2/2010

01-02-2010 | Original

Central neurological complications in critically ill patients with malignancies

Authors: Stéphane Legriel, Hélène Marijon, Michael Darmon, Virginie Lemiale, Jean-Pierre Bedos, Benoît Schlemmer, Elie Azoulay

Published in: Intensive Care Medicine | Issue 2/2010

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Abstract

Objective

To determine outcomes in critically ill patients hospitalized in the ICU for central neurological complications of cancer.

Design and setting

A 7-year retrospective study.

Subject and intervention

Observational study in 100 critically ill cancer patients with central neurological complications managed using standardized diagnostic and therapeutic strategies.

Measurements and results

There were 52 men and 48 women, aged 55 years (IQR, 40–65). Presenting manifestations were coma (56%), epilepsy (48%), focal signs (35%), encephalopathy (31%), and meningitis (7%). Cerebral imaging was abnormal in 61 patients, lumbar puncture in 17, and electroencephalography in 6. Neurosurgical biopsy was performed on four patients. The main etiologies included drug toxicity in 28, malignant brain infiltration in 21 patients, and cerebrovascular disease in 20. Mechanical ventilation was needed for 60 patients. Anticancer chemotherapy was administered during the ICU stay in 15 patients. ICU and hospital mortalities were 28 and 45%, respectively. By multivariate analysis, independent positive predictors of hospital mortality were poor performance status [odds ratio (OR) 2.94, 95% CI, 1.01–8.55, P = 0.047), focal signs at presentation (OR 3.52, 95% CI, 1.14–10.88, P = 0.029), abnormal lumbar puncture (OR 5.49, 95% CI 1.09–27.66, P = 0.038), and need for vasoactive drugs (OR 6.47, 95% CI 1.32–31.66, P = 0.021), whereas remission of the malignancy (OR 0.20, 95% CI 0.04–0.88, P = 0.033) and GCS score at admission (OR 0.81/point, 95% CI, 0.70–0.95, P = 0.009) were negative predictors of hospital mortality.

Conclusion

In cancer patients, central neurological events are mainly related to malignant brain infiltration and drug-related toxicity. Despite advanced severity, a standardized intensive management strategy yields a 55% hospital survival rate.
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Metadata
Title
Central neurological complications in critically ill patients with malignancies
Authors
Stéphane Legriel
Hélène Marijon
Michael Darmon
Virginie Lemiale
Jean-Pierre Bedos
Benoît Schlemmer
Elie Azoulay
Publication date
01-02-2010
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 2/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-009-1709-8

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