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Critical Care
Published in: Critical Care 1/2009

Open Access 01-02-2009 | Research

Characteristics and outcomes of cancer patients in European ICUs

Authors: Fabio Silvio Taccone, Antonio A Artigas, Charles L Sprung, Rui Moreno, Yasser Sakr, Jean-Louis Vincent

Published in: Critical Care | Issue 1/2009

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Abstract

Introduction

Increasing numbers of cancer patients are being admitted to the intensive care unit (ICU), either for cancer-related complications or treatment-associated side effects, yet there are relatively few data concerning the epidemiology and prognosis of cancer patients admitted to general ICUs. The aim of this study was to assess the characteristics of critically ill cancer patients, and to evaluate their prognosis.

Methods

This was a substudy of the Sepsis Occurrence in Acutely Ill Patients (SOAP) study, a cohort, multicentre, observational study that included data from all adult patients admitted to one of 198 participating ICUs from 24 European countries during the study period. Patients were followed up until death, hospital discharge or for 60 days.

Results

Of the 3147 patients enrolled in the SOAP study, 473 (15%) had a malignancy, 404 (85%) had solid tumours and 69 (15%) had haematological cancer. Patients with solid cancers had the same severity of illness as the non-cancer population, but were older, more likely to be a surgical admission and had a higher frequency of sepsis. Patients with haematological cancer were more severely ill and more commonly had sepsis, acute lung injury/acute respiratory distress syndrome, and renal failure than patients with other malignancies; these patients also had the highest hospital mortality rate (58%). The outcome of all cancer patients was comparable with that in the non-cancer population, with a 27% hospital mortality rate. However, in the subset of patients with more than three failing organs, more than 75% of patients with cancer died compared with about 50% of patients without cancer (p = 0.01).

Conclusions

In this large European study, patients with cancer were more often admitted to the ICU for sepsis and respiratory complications than other ICU patients. Overall, the outcome of patients with solid cancer was similar to that of ICU patients without cancer, whereas patients with haematological cancer had a worse outcome.
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Literature
1.
Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M: Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 2000, 28: 1322-1328. 10.1097/00003246-200005000-00011CrossRefPubMed
2.
Brenner H: Long-term survival rates of cancer patients achieved by the end of the 20th century: a period analysis. Lancet 2002, 360: 1131-1135. 10.1016/S0140-6736(02)11199-8CrossRefPubMed
3.
Azoulay E, Afessa B: The intensive care support of patients with malignancy: do everything that can be done. Intensive Care Med 2006, 32: 3-5. 10.1007/s00134-005-2835-6CrossRefPubMed
4.
Regazzoni CJ, Irrazabal C, Luna CM, Poderoso JJ: Cancer patients with septic shock: mortality predictors and neutropenia. Support Care Cancer 2004, 12: 833-839. 10.1007/s00520-004-0667-5CrossRefPubMed
5.
Groeger JS, White P Jr, Nierman DM, Glassman J, Shi W, Horak D, Price K: Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 1999, 17: 991-997.PubMed
6.
Rubenfeld GD, Crawford SW: Withdrawing life support from mechanically ventilated recipients of bone marrow transplants: a case for evidence-based guidelines. Ann Intern Med 1996, 125: 625-633.CrossRefPubMed
7.
Azoulay E, Pochard F, Chevret S, Vinsonneau C, Garrouste M, Cohen Y, Thuong M, Paugam C, Apperre C, De Cagny B, Brun F, Bornstain C, Parrot A, Thamion F, Lacherade JC, Bouffard Y, Le Gall JR, Herve C, Grassin M, Zittoun R, Schlemmer B, Dhainaut JF: Compliance with triage to intensive care recommendations. Crit Care Med 2001, 29: 2132-2136. 10.1097/00003246-200111000-00014CrossRefPubMed
8.
Faber-Langendoen K, Caplan AL, McGlave PB: Survival of adult bone marrow transplant patients receiving mechanical ventilation: a case for restricted use. Bone Marrow Transplant 1993, 12: 501-507.PubMed
9.
Khassawneh BY, White P Jr, Anaissie EJ, Barlogie B, Hiller FC: Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation. Chest 2002, 121: 185-188. 10.1378/chest.121.1.185CrossRefPubMed
10.
Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB: Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 1999, 160: 1957-1961.CrossRefPubMed
11.
Hilbert G, Gruson D, Vargas F, Valentino R, Gbikpi-Benissan G, Dupon M, Reiffers J, Cardinaud JP: Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med 2001, 344: 481-487. 10.1056/NEJM200102153440703CrossRefPubMed
12.
Sculier JP, Paesmans M, Markiewicz E, Berghmans T: Scoring systems in cancer patients admitted for an acute complication in a medical intensive care unit. Crit Care Med 2000, 28: 2786-2792. 10.1097/00003246-200008000-00018CrossRefPubMed
13.
Maschmeyer G, Bertschat FL, Moesta KT, Hausler E, Held TK, Nolte M, Osterziel KJ, Papstein V, Peters M, Reich G, Schmutzler M, Sezer O, Stula M, Wauer H, Wortz T, Wischnewsky M, Hohenberger P: Outcome analysis of 189 consecutive cancer patients referred to the intensive care unit as emergencies during a 2-year period. Eur J Cancer 2003, 39: 783-792. 10.1016/S0959-8049(03)00004-2CrossRefPubMed
14.
Vincent JL, Moreno R, Takala J, Willatts S, de Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996, 22: 707-710. 10.1007/BF01709751CrossRefPubMed
15.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D: Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006, 34: 344-353. 10.1097/01.CCM.0000194725.48928.3ACrossRefPubMed
16.
Velasco E, Thuler LC, Martins CA, Dias LM, Goncalves VM: Nosocomial infections in an oncology intensive care unit. Am J Infect Control 1997, 25: 458-462. 10.1016/S0196-6553(97)90067-5CrossRefPubMed
17.
Berghmans T, Crokaert F, Markiewicz E, Sculier JP: Epidemiology of infections in the adult medical intensive care unit of a cancer hospital. Support Care Cancer 1997, 5: 234-240. 10.1007/s005200050066CrossRefPubMed
18.
Danai PA, Moss M, Mannino DM, Martin GS: The epidemiology of sepsis in patients with malignancy. Chest 2006, 129: 1432-1440. 10.1378/chest.129.6.1432CrossRefPubMed
19.
ACCP-SCCM Consensus Conference: Definitions of sepsis and multiple organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992, 20: 864-874.CrossRef
20.
Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter P, Sprung C, Colardyn FC, Blecher S: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicentric, prospective study. Crit Care Med 1998, 26: 1793-1800.CrossRefPubMed
21.
Le Gall J-R, Lemeshow S, Saulnier F: A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993, 270: 2957-2963. 10.1001/jama.270.24.2957CrossRefPubMed
22.
Bruennler T, Mandraka F, Zierhut S, Siebig S, Wrede C, Klebl F, Holler E, Salzberger B, Schoelmerich J, Langgartner J: Outcome of hemato-oncologic patients with and without stem cell transplantation in a medical ICU. Eur J Med Res 2007, 12: 323-330.PubMed
23.
Williams MD, Braun LA, Cooper LM, Johnston J, Weiss RV, Qualy RL, Linde-Zwirble W: Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care 2004, 8: R291-R298. 10.1186/cc2893PubMedCentralCrossRefPubMed
24.
Ferra C, Marcos P, Misis M, Morgades M, Bordeje ML, Oriol A, Lloveras N, Sancho JM, Xicoy B, Batlle M, Klamburg J, Feliu E, Ribera JM: Outcome and prognostic factors in patients with hematologic malignancies admitted to the intensive care unit: a single-center experience. Int J Hematol 2007, 85: 195-202. 10.1532/IJH97.E0625CrossRefPubMed
25.
Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B: Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 2001, 29: 519-525. 10.1097/00003246-200103000-00009CrossRefPubMed
26.
Benoit DD, Depuydt PO, Vandewoude KH, Offner FC, Boterberg T, De Cock CA, Noens LA, Janssens AM, Decruyenaere JM: Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit. Intensive Care Med 2006, 32: 93-99. 10.1007/s00134-005-2836-5CrossRefPubMed
27.
Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Régnier B, The French ICU Group for Severe Sepsis: Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. JAMA 1995, 274: 968-974. 10.1001/jama.274.12.968CrossRefPubMed
28.
Groeger JS, Lemeshow S, Price K, Nierman DM, White P Jr, Klar J, Granovsky S, Horak D, Kish SK: Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 1998, 16: 761-770.PubMed
29.
Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall JR, Schlemmer B: Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 2000, 26: 1817-1823. 10.1007/s001340051350CrossRefPubMed
30.
Massion PB, Dive AM, Doyen C, Bulpa P, Jamart J, Bosly A, Installe E: Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med 2002, 30: 2260-2270. 10.1097/00003246-200210000-00014CrossRefPubMed
31.
Sculier JP, Markiewicz E: Medical cancer patients and intensive care. Anticancer Res 1991, 11: 2171-2174.PubMed
32.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR: Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001, 29: 1303-1310. 10.1097/00003246-200107000-00002CrossRefPubMed
33.
Blot F, Guiguet M, Nitenberg G, Leclercq B, Gachot B, Escudier B: Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures. Eur J Cancer 1997, 33: 1031-1037. 10.1016/S0959-8049(97)00042-7CrossRefPubMed
34.
Vincent JL, Bihari D, Suter PM, Bruining HA, White JL, Nicolas-Chanoine MH, Wolff M, Spencer RJ, Hemmer M, Members of the EPIC International Advisory Group: The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) study. EPIC International Advisory Committee. JAMA 1995, 274: 639-644. 10.1001/jama.274.8.639CrossRefPubMed
35.
Poletti V, Salvucci M, Zanchini R, Molinari AL, Zuffa E, Poletti G, Zaccaria A: The lung as a target organ in patients with hematologic disorders. Haematologica 2000, 85: 855-864.PubMed
36.
Cheng MF, Yang YL, Yao TJ, Lin CY, Liu JS, Tang RB, Yu KW, Fan YH, Hsieh KS, Ho M, Lo HJ: Risk factors for fatal candidemia caused by Candida albicans and non-albicans Candida species. BMC Infect Dis 2005, 5: 22. 10.1186/1471-2334-5-22PubMedCentralCrossRefPubMed
37.
HeadleyJ, TheriaultR, Smith TL:Independent validation of APACHE II severity of illness score for predicting mortality in patients with breast cancer admitted to the intensive care unit. Cancer 1992, 70: 497-503. PublisherFullTex​t 10.1002/1097-0142(19920715)70:2497::AID-CNCR28207002203.0.CO;2-HCrossRefPubMed
38.
Guiguet M, Blot F, Escudier B, Antoun S, Leclercq B, Nitenberg G: Severity-of-illness scores for neutropenic cancer patients in an intensive care unit: Which is the best predictor? Do multiple assessment times improve the predictive value? Crit Care Med 1998, 26: 488-493. 10.1097/00003246-199803000-00020CrossRefPubMed
39.
Silfvast T, Pettila V, Ihalainen A, Elonen E: Multiple organ failure and outcome of critically ill patients with haematological malignancy. Acta Anaesthesiol Scand 2003, 47: 301-306. 10.1034/j.1399-6576.2003.00058.xCrossRefPubMed
40.
Cornet AD, Issa AI, Loosdrecht AA, Ossenkoppele GJ, Strack van Schijndel RJ, Groeneveld AB: Sequential organ failure predicts mortality of patients with a haematological malignancy needing intensive care. Eur J Haematol 2005, 74: 511-516. 10.1111/j.1600-0609.2005.00418.xCrossRefPubMed
41.
Estopa R, Torres MA, Kastanos N, Rives A, Agusti-Vidal A, Rozman C: Acute respiratory failure in severe hematologic disorders. Crit Care Med 1984, 12: 26-28. 10.1097/00003246-198401000-00007CrossRefPubMed
42.
Kroschinsky F, Weise M, Illmer T, Haenel M, Bornhaeuser M, Hoeffken G, Ehninger G, Schuler U: Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies. Intensive Care Med 2002, 28: 1294-1300. 10.1007/s00134-002-1420-5CrossRefPubMed
43.
Larche J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G, Darmon M, Le Gall JR, Schlemmer B: Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 2003, 29: 1688-1695. 10.1007/s00134-003-1957-yCrossRefPubMed
Metadata
Title
Characteristics and outcomes of cancer patients in European ICUs
Authors
Fabio Silvio Taccone
Antonio A Artigas
Charles L Sprung
Rui Moreno
Yasser Sakr
Jean-Louis Vincent
Publication date
01-02-2009
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc7713

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