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01-02-2021 | Solid Tumor | Original

Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study

Authors: Fernando G. Zampieri, Thiago G. Romano, Jorge I. F. Salluh, Leandro U. Taniguchi, Pedro V. Mendes, Antonio P. Nassar Jr, Roberto Costa, William N. Viana, Marcelo O. Maia, Mariza F. A. Lima, Sylas B. Cappi, Alexandre G. R. Carvalho, Fernando V. C. De Marco, Marcelo S. Santino, Eric Perecmanis, Fabio G. Miranda, Grazielle V. Ramos, Aline R. Silva, Paulo M. Hoff, Fernando A. Bozza, Marcio Soares

Published in: Intensive Care Medicine | Issue 2/2021

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.

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Azoulay E, Schellongowski P, Darmon M et al (2017) The intensive care medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med 43:1366–1382. https://doi.org/10.1007/s00134-017-4884-zCrossRefPubMed

Puxty K, McLoone P, Quasim T et al (2015) Risk of critical illness among patients with solid cancers: a population-based observational study. JAMA Oncol 1:1078–1085. https://doi.org/10.1001/jamaoncol.2015.2855CrossRef

Soares M, Bozza FA, Azevedo LCP et al (2016) Effects of organizational characteristics on outcomes and resource use in patients with cancer admitted to intensive care units. J Clin Oncol Off J Am Soc Clin Oncol 34:3315–3324. https://doi.org/10.1200/JCO.2016.66.9549CrossRef

Shimabukuro-Vornhagen A, Böll B, Kochanek M et al (2016) Critical care of patients with cancer. CA Cancer J Clin 66:496–517. https://doi.org/10.3322/caac.21351CrossRefPubMed

Gutierrez C, McEvoy C, Munshi L et al (2020) Critical care management of toxicities associated with targeted agents and immunotherapies for cancer. Crit Care Med 48:10–21. https://doi.org/10.1097/CCM.0000000000004087CrossRefPubMedPubMedCentral

Azoulay E, Shimabukuro-Vornhagen A, Darmon M, von Bergwelt-Baildon M (2019) Critical care management of chimeric antigen receptor T cell-related toxicity. Be aware and prepared. Am J Respir Crit Care Med 200:20–23. https://doi.org/10.1164/rccm.201810-1945EDCrossRefPubMed

Azoulay E, Pickkers P, Soares M et al (2017) Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study. Intensive Care Med 43:1808–1819. https://doi.org/10.1007/s00134-017-4947-1CrossRefPubMed

Chaudhuri D, Tanuseputro P, Herritt B et al (2017) Critical care at the end of life: a population-level cohort study of cost and outcomes. Crit Care Lond Engl 21:124. https://doi.org/10.1186/s13054-017-1711-4CrossRef

Ostermann M, Ferrando-Vivas P, Gore C et al (2017) Characteristics and outcome of cancer patients admitted to the ICU in England, Wales, and Northern Ireland and national trends between 1997 and 2013. Crit Care Med 45:1668–1676. https://doi.org/10.1097/CCM.0000000000002589CrossRefPubMed

10.

de Vries VA, Müller MCA, Sesmu Arbous M et al (2018) Time trend analysis of long term outcome of patients with haematological malignancies admitted at dutch intensive care units. Br J Haematol 181:68–76. https://doi.org/10.1111/bjh.15140CrossRef

11.

Darmon M, Bourmaud A, Georges Q et al (2019) Changes in critically ill cancer patients’ short-term outcome over the last decades: results of systematic review with meta-analysis on individual data. Intensive Care Med 45:977–987. https://doi.org/10.1007/s00134-019-05653-7CrossRef

12.

Azoulay E, Mokart D, Pène F et al (2013) Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium–a groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol Off J Am Soc Clin Oncol 31:2810–2818. https://doi.org/10.1200/JCO.2012.47.2365CrossRef

13.

Slatore CG, Cecere LM, Letourneau JL et al (2012) Intensive care unit outcomes among patients with lung cancer in the surveillance, epidemiology, and end results-medicare registry. J Clin Oncol Off J Am Soc Clin Oncol 30:1686–1691. https://doi.org/10.1200/JCO.2011.40.0846CrossRef

14.

Wallace SK, Rathi NK, Waller DK et al (2016) Two decades of ICU utilization and hospital outcomes in a comprehensive cancer center. Crit Care Med 44:926–933. https://doi.org/10.1097/CCM.0000000000001568CrossRefPubMed

15.

Zampieri FG, Soares M, Borges LP et al (2017) The Epimed Monitor ICU Database^®: a cloud-based national registry for adult intensive care unit patients in Brazil. Rev Bras Ter Intensiva 29:418–426. https://doi.org/10.5935/0103-507X.20170062CrossRefPubMedPubMedCentral

16.

Zampieri FG, Bozza FA, Moralez GM et al (2017) The effects of performance status one week before hospital admission on the outcomes of critically ill patients. Intensive Care Med 43:39–47. https://doi.org/10.1007/s00134-016-4563-5CrossRefPubMed

17.

Moreno RP, Metnitz PGH, Almeida E et al (2005) SAPS 3–From evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 31:1345–1355. https://doi.org/10.1007/s00134-005-2763-5CrossRefPubMedPubMedCentral

18.

Gerds TA, Blanche P, Mortensen R et al (2020) Risk regression: risk regression models and prediction scores for survival analysis with competing risks. https://cran.r-project.org/web/packages/riskRegression/index.html. Accessed 08 May 2020

19.

Soares M, Toffart A-C, Timsit J-F et al (2014) Intensive care in patients with lung cancer: a multinational study. Ann Oncol Off J Eur Soc Med Oncol ESMO 25:1829–1835. https://doi.org/10.1093/annonc/mdu234CrossRef

20.

Azevedo LCP, Caruso P, Silva UVA et al (2014) Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest 146:257–266. https://doi.org/10.1378/chest.13-1870CrossRefPubMed

21.

Azoulay E, Mokart D, Kouatchet A et al (2019) Acute respiratory failure in immunocompromised adults. Lancet Respir Med 7:173–186. https://doi.org/10.1016/S2213-2600(18)30345-XCrossRefPubMed

Title: Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study
Authors: Fernando G. Zampieri
Thiago G. Romano
Jorge I. F. Salluh
Leandro U. Taniguchi
Pedro V. Mendes
Antonio P. Nassar Jr
Roberto Costa
William N. Viana
Marcelo O. Maia
Mariza F. A. Lima
Sylas B. Cappi
Alexandre G. R. Carvalho
Fernando V. C. De Marco
Marcelo S. Santino
Eric Perecmanis
Fabio G. Miranda
Grazielle V. Ramos
Aline R. Silva
Paulo M. Hoff
Fernando A. Bozza
Marcio Soares
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Solid Tumor
Care
Published in: Intensive Care Medicine / Issue 2/2021
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06184-2

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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

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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