Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2016

Open Access 01-12-2016 | Research article

Intensive care unit prognostic factors in critically ill patients with advanced solid tumors: a 3-year retrospective study

Authors: Rui Xia, Donghao Wang

Published in: BMC Cancer | Issue 1/2016

Login to get access

Abstract

Background

The objective of this study was to identify risk factors predicting prognosis of critically ill medical patients with advanced solid tumors in the intensive care unit (ICU).

Methods

We retrospectively analyzed all ICU unplanned medical admissions to the ICU of patients with advanced solid cancer in Tianjin Medical University Cancer Institute and Hospital between October 1, 2012 and March 1, 2015. Approval was obtained from the Ethical Commission of Tianjin Medical University Cancer Institute and Hospital to review and publish information from patients’ records.

Results

One hundred and forty-one patients with full code status met the criteria for inclusion from among 813 ICU admissions. ICU mortality was 14.9 % and in-hospital mortality was 29.8 %. The major reasons for unplanned ICU admission were respiratory failure (38.3 %) and severe sepsis or septic shock (27.7 %). The ICU mortality in patients who required vasopressors, mechanical ventilation or renal replacement therapy for >24 h was 25, 25.9 and 40 %, respectively. The mean overall survival was 28.6 months. After adjusting for hypertension, type of solid cancer, intervention time, need for mechanical ventilation and Acute Physiology and Chronic Health Evaluation II score, only Sepsis-related Organ Failure Assessment (SOFA) score on day 7 of ICU treatment remained a significant predictor of ICU mortality (adjusted odds ratio 1.612, 95 % confidence interval 1.137–2.285, P = 0.007).

Conclusions

We suggest broadening the criteria for ICU admission. The patients should be allowed an ICU trial consisting of unlimited ICU support, including invasive hemodynamic monitoring, mechanical ventilation and renal replacement therapy. An interdisciplinary meeting, including an ethics consultation, should be held to make end-of-life decisions if the SOFA score on day 7 shows clinical deterioration with no available therapeutic options.
Literature
1.
Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the human development index (2008–2030): a population-based study. Lancet Oncol. 2012;13:790–801.CrossRefPubMed
2.
Nazer LH, Hawari F, Al-Najjar T. Adverse drug events in critically ill patients with cancer: incidence, characteristics, and outcomes. J Pharm Pract. 2014;27:208–13.CrossRefPubMed
3.
Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129:1432–40.CrossRefPubMed
4.
Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL. Characteristics and outcomes of cancer patients in European ICUs. Crit Care. 2009;13:R15.CrossRefPubMedPubMedCentral
5.
Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B. Intensive care of the cancer patients: recent achievements and remaining challenges. Ann Intensive Care. 2011;1:5.CrossRefPubMedPubMedCentral
6.
von Bergwelt-Baildon M, Hallek MJ, Shimabukuro-Vornhagen AA, Kochanek M. CCC meets ICU: Redefining the role of critical care of cancer patients. BMC Cancer. 2010;10:612.CrossRef
7.
Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, et al. Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med. 2001;29:519–25.CrossRefPubMed
8.
Soubani AO, Shehada E, Chen W, Smith D. The outcome of cancer patients with acute respiratory distress syndrome. J Crit Care. 2014;29:183. e7-e12.CrossRefPubMed
9.
Wigmore TJ, Farquhar-Smith P, Lawson A. Intensive care for the cancer patient - unique clinical and ethical challenges and outcome prediction in the critically ill cancer patient. Best Pract Res Clin Anaesthesiol. 2013;27:527–43.CrossRefPubMed
10.
Gruber PC, Achilleos A, Speed D, Wigmore TJ. Long-stay patients with cancer on the intensive care unit: characteristics, risk factors, and clinical outcomes. Br J Anaesth. 2013;111:1026–7.CrossRefPubMed
11.
de Jonge E. Patients with cancer on the ICU: Time for optimism. Neth J Med. 2014;72:60–1.PubMed
12.
Kostakou E, Rovina N, Kyriakopoulou M, Koulouris NG, Koutsoukou A. Critically ill cancer patient in intensive care unit: issues that arise. J Crit Care. 2014;29:817–22.CrossRefPubMed
13.
Choi Y, Keam B, Kim TM, Lee SH, Kim DW, Heo DS. Cancer treatment near the end-of-life becomes more aggressive: Changes in trend during 10 years at a single institute. Cancer Res Treat. 2015. doi:10.​4143/​crt.​2014.​200.
14.
Goldman L, Hashimoto B, Cook EF, Loscalzo A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: Advantages of a new specific activity scale. Circulation. 1981;64:1227–34.CrossRefPubMed
15.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580–637.CrossRefPubMed
16.
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.CrossRefPubMed
17.
Rosolem MM, Rabello LS, Lisboa T, Caruso P, Costa RT, Leal JV, et al. Critically ill patients with cancer and sepsis: clinical course and prognostic factors. J Crit Care. 2012;27:301–7.CrossRefPubMed
18.
Aygencel G, Turkoglu M, Turkoz Sucak G, Benekli M. Prognostic factors in critically ill cancer patients admitted to the intensive care unit. J Crit Care. 2014;29:618–26.CrossRefPubMed
19.
Mokart D, Etienne A, Esterni B, Brun JP, Chow-Chine L, Sannini A, et al. Critically ill cancer patients in the intensive care unit: short-term outcome and 1-year mortality. Acta Anaesthesiol Scand. 2012;56:178–89.CrossRefPubMed
20.
Song JU, Suh GY, Park HY, Lim SY, Han SG, Kang YR, et al. Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units. Intensive Care Med. 2012;38:1505–13.CrossRefPubMed
21.
Bos MM, de Keizer NF, Meynaar IA, Bakhshi-Raiez F, de Jonge E. Outcomes of cancer patients after unplanned admission to general intensive care units. Acta Oncol. 2012;51:897–905.CrossRefPubMed
22.
Soares M, Caruso P, Silva E, Teles J, Lobo S, Friedman G, et al. Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med. 2010;38:9–15.CrossRefPubMed
23.
Maccariello E, Valente C, Nogueira L, Bonomo Jr H, Ismael M, Machado JE, et al. Outcomes of cancer and non-cancer patients with acute kidney injury and need of renal replacement therapy admitted to general intensive care units. Nephrol Dial Transplant. 2011;26:537–43.CrossRefPubMed
24.
de Montmollin E, Tandjaoui-Lambiotte Y, Legrand M, Lambert J, Mokart D, Kouatchet A, et al. Outcomes in critically ill cancer patients with septic shock of pulmonary origin. Shock. 2013;39:250–4.CrossRefPubMed
25.
Voigt LP, Rajendram P, Shuman AG, Kamat S, McCabe MS, Kostelecky N, et al. Characteristics and outcome of ethics consultations in an oncologic intensive care unit. J Intensive Care Med. 2014. doi:10.​1177/​0885066614538389​.PubMed
26.
Thiéry G, Azoulay E, Darmon M, Ciroldi M, Miranda SD, Levy V, et al. Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol. 2005;23:4406–13.CrossRefPubMed
27.
Reichner CA, Thompson JA, O’Brien S, Kuru T, Anderson ED. Outcome and code status of lung cancer patients admitted to the medical ICU. Chest. 2006;130:719–23.CrossRefPubMed
28.
Park SY, Lim SY, Um SW, koh WJ, Chung MP, Kim H, et al. Outcome and predictors of mortality in patients requiring invasive mechanical ventilation due to acute respiratory failure while undergoing ambulatory chemotherapy for solid cancers. Support Care Cancer. 2013;21:1647–53.CrossRefPubMed
29.
Park CM, Koh Y, Jeon K, Na S, Lim CM, Choi WI, et al. Impact of Eastern Cooperative Oncology Group Performance Status on hospital mortality in critically ill patients. J Crit Care. 2014;29:409–13.CrossRefPubMed
30.
Carlet J, Thijs LG, Antonelli M, Cassell J, Cox P, Hill N, et al. Challenges in end-of-life care in the ICU. Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003. Intensive Care Med. 2004;30:770–84.CrossRefPubMed
31.
Obermeyer Z, Makar M, Abujaber S, Dominici F, Block S, Cutler DM. Asscociation between the Medicare hospice benefit and health care utilization and costs for patients with poor-prognosis cancer. JAMA. 2014;312:1888–96.CrossRefPubMedPubMedCentral
32.
33.
Cruz VM, Camalionte L, Caruso P. Factors associated with futile end-of-life intensive care in a cancer hospital. Am J Hosp Palliat Care. 2015;32:329–34.CrossRefPubMed
Metadata
Title
Intensive care unit prognostic factors in critically ill patients with advanced solid tumors: a 3-year retrospective study
Authors
Rui Xia
Donghao Wang
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2016
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-016-2242-0

Other articles of this Issue 1/2016

BMC Cancer 1/2016 Go to the issue

Research article

Comparative analysis of copy number variations in ulcerative colitis associated and sporadic colorectal neoplasia

Research article

Methionine-restricted diet inhibits growth of MCF10AT1-derived mammary tumors by increasing cell cycle inhibitors in athymic nude mice

Research article

Treatment of a chemoresistant neuroblastoma cell line with the antimalarial ozonide OZ513

Research article

Expression of Par3 polarity protein correlates with poor prognosis in ovarian cancer

Research article

5-lipoxygenase mediates docosahexaenoyl ethanolamide and N-arachidonoyl-L-alanine-induced reactive oxygen species production and inhibition of proliferation of head and neck squamous cell carcinoma cells

Study protocol

Protocol for a mixed methods longitudinal enquiry into the impact of a community based supportive service for people affected by cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits