Impact of early ICU admission on outcome of critically ill and critically ill cancer patients: A systematic review and meta-analysis.

Abstract Background Although several international guidelines recommend early over late intubation of patients with severe coronavirus disease 2019 (COVID-19), this issue is still controversial. We aimed to investigate the effect (if any) of timing of intubation on clinical outcomes of critically ill patients with COVID-19 by carrying out a systematic review and meta-analysis. Methods PubMed and Scopus were systematically searched, while references and preprint servers were explored, for relevant articles up to December 26, 2020, to identify studies which reported on mortality and/or morbidity of patients with COVID-19 undergoing early versus late intubation. “Early” was defined as intubation within 24 h from intensive care unit (ICU) admission, while “late” as intubation at any time after 24 h of ICU admission. All-cause mortality and duration of mechanical ventilation (MV) were the primary outcomes of the meta-analysis. Pooled risk ratio (RR), pooled mean difference (MD) and 95% confidence intervals (CI) were calculated using a random effects model. The meta-analysis was registered with PROSPERO (CRD42020222147). Results A total of 12 studies, involving 8944 critically ill patients with COVID-19, were included. There was no statistically detectable difference on all-cause mortality between patients undergoing early versus late intubation (3981 deaths; 45.4% versus 39.1%; RR 1.07, 95% CI 0.99–1.15, p = 0.08). This was also the case for duration of MV (1892 patients; MD − 0.58 days, 95% CI − 3.06 to 1.89 days, p = 0.65). In a sensitivity analysis using an alternate definition of early/late intubation, intubation without versus with a prior trial of high-flow nasal cannula or noninvasive mechanical ventilation was still not associated with a statistically detectable difference on all-cause mortality (1128 deaths; 48.9% versus 42.5%; RR 1.11, 95% CI 0.99–1.25, p = 0.08). Conclusions The synthesized evidence suggests that timing of intubation may have no effect on mortality and morbidity of critically ill patients with COVID-19. These results might justify a wait-and-see approach, which may lead to fewer intubations. Relevant guidelines may therefore need to be updated.

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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 Medicine ◽

10.1007/s00134-019-05653-7 ◽

2019 ◽

Vol 45 (7) ◽

pp. 977-987 ◽

Cited By ~ 24

Author(s):

Michaël Darmon ◽

Aurélie Bourmaud ◽

Quentin Georges ◽

Marcio Soares ◽

Kyeongman Jeon ◽

...

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Critically Ill ◽

Meta Analysis ◽

Individual Data ◽

Short Term ◽

Term Outcome ◽

Short Term Outcome

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Epidemiology, clinical characteristics and treatment of critically ill patients with COVID-19): a protocol for a living systematic review

BMJ Open ◽

10.1136/bmjopen-2020-042008 ◽

2021 ◽

Vol 11 (1) ◽

pp. e042008

Author(s):

Lazar Milovanovic ◽

Erin Hessey ◽

Meghan Sebastianski ◽

Diana Keto-Lambert ◽

Ben Vandermeer ◽

...

Keyword(s):

Systematic Review ◽

Critically Ill ◽

Critically Ill Patients ◽

Search Strategy ◽

Meta Analysis ◽

Case Series ◽

Case Fatality ◽

Cochrane Library ◽

Icu Admission ◽

Epidemiological Characteristics

IntroductionIn December 2019, the first cases of COVID-19 associated with SARS-CoV-2 viral infection were described in Wuhan, Hubei Province, China. Since then, it has spread rapidly affecting 188 countries and was declared a pandemic by the WHO on 11 March 2020. Preliminary reports suggest up to 30% of patients require intensive care unit (ICU) admission and case fatality rate estimate is 2.3%–7.2%. The primary reason for ICU admission is hypoxaemic respiratory failure, while factors associated with ICU admission include increased age, presence of comorbidities and cytokine storm. Case series and retrospective trials initially assessed proposed treatments with randomised controlled trials now reporting early outcomes. We conduct a systematic review and meta-analysis to identify epidemiological factors, treatments and complications that predict mortality among critically ill patients with COVID-19.Methods and analysisOur comprehensive search strategy was developed in consultation with a research librarian. We will search electronic databases: Ovid Medline, Ovid Embase, Ovid Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Wiley Cochrane Library. The search strategy combines concepts from COVID-19, validated COVID-19 search filters and geographical locations of large outbreaks. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. Clinically homogenous epidemiological characteristics, interventions and complications will be pooled in statistical meta-analysis. Within the framework of a living systematic review, the search and data analysis will be updated every 6 months.Ethics and disseminationOur systematic review will synthesise literature on risk factors and interventions associated with mortality in critically ill patients with COVID-19. Results will be presented at national and international conferences and submitted for peer-reviewed publication. The pooled analysis can provide guidance to inform clinical guidelines for care of critically ill patients with COVID-19. Iterative updates will be made public through open access. Research ethics approval is not required.PROSPERO registration numberCRD42020176672.

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Outcomes in adult critically Ill cancer patients with and without neutropenia: a systematic review and meta-analysis of the Groupe de Recherche en Réanimation Respiratoire du patient d'Onco-Hématologie (GRRR-OH)

Oncotarget ◽

10.18632/oncotarget.12165 ◽

2016 ◽

Vol 8 (1) ◽

pp. 1860-1870 ◽

Cited By ~ 22

Author(s):

Marie Bouteloup ◽

Sophie Perinel ◽

Aurélie Bourmaud ◽

Elie Azoulay ◽

Djamel Mokart ◽

...

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Critically Ill ◽

Meta Analysis

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Mortality in Cancer Patients With COVID-19 Who Are Admitted to an ICU or Who Have Severe COVID-19: A Systematic Review and Meta-Analysis

JCO Global Oncology ◽

10.1200/go.21.00072 ◽

2021 ◽

pp. 1286-1305

Author(s):

Amogh Rajeev Nadkarni ◽

Swapna C. Vijayakumaran ◽

Sudeep Gupta ◽

Jigeeshu V. Divatia

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Critically Ill ◽

Odds Ratio ◽

Hematologic Malignancy ◽

Meta Analysis ◽

Risk Of Bias ◽

Cancer Subtypes ◽

Newcastle Ottawa Scale ◽

Random Effects Modeling

PURPOSE There are scarce data to aid in prognostication of the outcome of critically ill cancer patients with COVID-19. In this systematic review and meta-analysis, we investigated the mortality of critically ill cancer patients with COVID-19. METHODS We searched online databases and manually searched for studies in English that reported on outcomes of adult cancer patients with COVID-19 admitted to an intensive care unit (ICU) or those with severe COVID-19 between December 2019 and October 2020. Risk of bias was assessed by the Modified Newcastle-Ottawa Scale. The primary outcome was all-cause mortality. We also determined the odds of death for cancer patients versus noncancer patients, as also outcomes by cancer subtypes, presence of recent anticancer therapy, and presence of one or more comorbidities. Random-effects modeling was used. RESULTS In 28 studies (1,276 patients), pooled mortality in cancer patients with COVID-19 admitted to an ICU was 60.2% (95% CI, 53.6 to 6.7; I2 = 80.27%), with four studies (7,259 patients) showing higher odds of dying in cancer versus noncancer patients (odds ratio 1.924; 95% CI, 1.596 to 2.320). In four studies (106 patients) of patients with cancer and severe COVID-19, pooled mortality was 59.4% (95% CI, –39.4 to 77.5; I2 = 72.28%); in one study, presence of hematologic malignancy was associated with significantly higher mortality compared with nonhematologic cancers (odds ratio 1.878; 95% CI, 1.171 to 3.012). Risk of bias was low. CONCLUSION Most studies were reported before the results of trials suggesting the benefit of dexamethasone and tocilizumab, potentially overestimating mortality. The observed mortality of 60% in cancer patients with COVID-19 admitted to the ICU is not prohibitively high, and admission to the ICU should be considered for selected patients (registered with PROSPERO, CRD42020207209).

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