Effect of the underlying malignancy on critically ill septic patient's outcome

Abstract BackgroundTo explore risk factors for unfavorable outcome (death or requiring invasive mechanical ventilation at 28 days from ICU admission) of critically ill COVID-19 patients hospitalized in the Toulouse regionMethodsRetrospective cohort of critically ill COVID-19 patients sequentially admitted to 12 ICUs in Toulouse region (March 9, 2020, to April 8, 2020). All patients had laboratory confirmed SARS-CoV-2 infection and required invasive mechanical ventilation. Baseline characteristics, pathophysiological respiratory data, clinical outcomes, viral shredding, and chest CT scan were collected.ResultsA total of 150 patients were included (median age, 68 years (interquartile range, (IQR), 58-72; 81% male). The most common comorbidities were hypertension (77, 51%) and obesity (42, 28%). At ICU admission, the median PaO2/FiO2 ratio was 138 (IQR,112-178). During hospitalization, the rate of ventilator-acquired pneumonia (VAP) was 61% and 51 (34%) patients had acute kidney injury (AKI) with a Kidney Disease Improving Global Outcomes (KDIGO) score > 1. The 28-day mortality was 15.3%, and 50 (33%) patients had unfavorable outcome. We found that VAP (5.91; 2.10-10.03; p value = 0.002) and AKI with a KDIGO score > 1 (4.71; 1.69-14.41; p value = 0.004) were associated with increased odds of unfavorable outcome. Neither, chest CT scan data on admission, nor pathophysiological respiratory data during ICU stay were associated to patient’s outcome.ConclusionThe potential risk factors of AKI and VAP could help clinicians to identify patients with poor prognosis at an early stage. Targeted care of these factors might have a significant impact on COVID-19 patient’s outcome.

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Treatment Limitation Decisions in Critically Ill Patients With a Malignancy on the Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/0885066620948453 ◽

2020 ◽

Vol 36 (1) ◽

pp. 42-50

Author(s):

Esther N. van der Zee ◽

Jelle L. Epker ◽

Jan Bakker ◽

Dominique D. Benoit ◽

Erwin J. O. Kompanje

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Binary Logistic Regression ◽

University Hospital ◽

Future Research ◽

Binary Logistic Regression Analysis ◽

Underlying Malignancy ◽

Life Saving ◽

Treatment Limitation ◽

Unplanned Admissions

Background: Treatment limitation decisions (TLDs) on the ICU can be challenging, especially in patients with a malignancy. Up-to-date literature regarding TLDs in critically ill patients with a malignancy admitted to the ICU is scarce. The aim was to compare the incidence of written TLDs between patients with an active malignancy, patients with a malignancy in their medical history (complete remission, CR) and patients without a malignancy admitted unplanned to the ICU. Methods: We conducted a retrospective cohort study in a large university hospital in the Netherlands. We identified all unplanned admissions to the ICU in 2017 and categorized the patients in 3 groups: patients with an active malignancy (study population), with CR and without a malignancy. A TLD was defined as a written instruction not to perform life-saving treatments, such as CPR in case of cardiac arrest. A multivariate binary logistic regression analysis was used to identify whether having a malignancy was associated with TLDs. Results: Of the 1046 unplanned admissions, 125 patients (12%) had an active malignancy and 76 (7.3%) patients had CR. The incidence of written TLDs in these subgroups were 37 (29.6%) and 20 (26.3%). Age (OR 1.03; 95% CI 1.01 -1.04), SOFA score at ICU admission (OR 1.11; 95% CI 1.05 -1.18) and having an active malignancy (OR 1.75; 95% CI 1.04-2.96) compared to no malignancy were independently associated with written TLDs. SOFA scores on the day of the TLD were not significantly different in patients with and without a malignancy. Conclusions: This study shows that the presence of an underlying malignancy is independently associated with written TLDs during ICU stay. Patients with CR were not at risk of more written TLDs. Whether this higher incidence of TLDs in patients with a malignancy is justified, is at least questionable and should be evaluated in future research.

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