Outcomes of Patients with Malignancy Admitted to the Intensive Care Units: A Prospective Study

Introduction. Decisions regarding whether advanced cancer patients should be admitted to the ICU are based on a complex suite of considerations, including short- and long-term prognosis, quality of life, and therapeutic options to treat cancer. We aimed to describe demographic, clinical, and survival data and to identify factors associated with mortality in critically ill advanced cancer patients with nonelective admissions to general ICUs. Materials and Methods. Critically ill adult (≥18 years old) cancer patients nonelectively admitted to the intensive care units at the American University of Beirut Medical Center between August 1st 2015 and March 1st 2019 were included. Demographic, clinical, and laboratory data were prospectively collected from the first day of ICU admission up to 30 days after discharge. This study was strictly observational, and clinical decisions were left to the discretion of the ICU team and attending physician. Results. 272 patients were enrolled in the study between August 1st 2015 and March 1st 2019, with an ICU mortality rate of 43.4%, with the number rising to 59% within 30 days of ICU discharge. The mean length of stay in our ICU was 14 days (IQR: 1–120) with a median overall survival of 22 days since the date of ICU admission. The major reasons for unplanned ICU admission were sepsis/septic shock (54%) and respiratory failure (33.1%). Cox regression analysis revealed 7 major predictors of poor prognosis. Direct admission from the ED was associated with a higher risk of mortality (48.9%) than being transferred from the floor (32.6%) ( p = 0.014 ). Conclusion. Our study has shown that being directly admitted to the ICU from the ED rather than being transferred from regular wards, developing AKI, sepsis, MOF, and ARDS, or having an uncontrolled malignancy are all predictive factors for short-term mortality in critically ill cancer patients nonelectively admitted to the ICU. Vasopressor use and mechanical ventilation were also predictors of mortality.

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Outcomes of patients with malignancy admitted to the intensive care units (ICU): A prospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24001 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24001-e24001

Author(s):

Hazem Assi ◽

Ibrahim Alameh ◽

Maroun Bou Zerdan ◽

Maya Charafeddine ◽

Jessica Khoury ◽

...

Keyword(s):

Intensive Care ◽

Cancer Patients ◽

Intensive Care Units ◽

Critically Ill ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Icu Admission ◽

Icu Discharge ◽

Short And Long Term

e24001 Background: An important aspect of improving outcomes for patients with malignancy is the provision of critical care during periods of acute deterioration. Decisions regarding whether advanced cancer patients should be admitted to the ICU is based on a complex suite of considerations, including short- and long-term prognosis, quality of life, and therapeutic options to treat cancer. We set to describe demographic, clinical, and survival data and to identify factors associated with short- and long-term mortality in critically ill advanced cancer patients with non-elective admissions to general ICUs. Methods: Critically ill adult (≥18-year-old) cancer patients non-electively admitted to the intensive care units at the American University of Beirut Medical Center (AUBMC) between August 1st, 2015, and March 1st, 2019, were included. Demographic, clinical, and laboratory data was prospectively collected from first day of ICU admission up to 30 days after discharge. This study was strictly observational and clinical decisions were left to the discretion of the ICU team and attending physician. Results: Two hundred seventy-two patients were enrolled in the study between August 1st, 2015, and March 31st, 2019, with an ICU mortality rate of 43.4%, with the number rising to 59% within 30 days of ICU discharge. Mean length of stay in our ICU was 14 days with an interquartile range of 1 to 120 days with a median overall survival of 22 days since date of ICU admission. The major reasons for unplanned ICU admission were sepsis/septic shock (54%) and respiratory failure (33.1%). COX regression analysis showed that sepsis, uncontrolled malignancy, ARDS, multi-organ failure, use of vasopressors, use of mechanical ventilation are major predictors of poor prognosis. Direct admission from the ED was associated with a higher risk of mortality (48.9%) than being transferred from the floor (32.6%) (p = 0.014). Additionally, mortality in patients with solid malignancies (47.6%) was higher than those with hematologic malignancies (34.1%) (p = 0.0048). Conclusions: Patients admitted to the ICU in a tertiary care center in the MENA region are at high risk for short term mortality.

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Prognostic factors associated with recovery from mechanical ventilation in advanced cancer patients admitted to intensive care units

Journal of Clinical Oncology ◽

10.1200/jco.2005.23.16_suppl.8179 ◽

2005 ◽

Vol 23 (16_suppl) ◽

pp. 8179-8179

Author(s):

S. Kim ◽

D. S. Heo ◽

I. I. Na ◽

E. K. Song ◽

H. C. Shin ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Prognostic Factors ◽

Cancer Patients ◽

Intensive Care Units ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Factors Associated

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Knowledge, attitude, and practice toward the daily management of PICC in critically ill cancer patients discharged from intensive care units

Cancer Management and Research ◽

10.2147/cmar.s166008 ◽

2018 ◽

Vol Volume 10 ◽

pp. 1565-1574 ◽

Cited By ~ 3

Author(s):

Jie Chen ◽

Hui Zhao ◽

Zhijie Xia ◽

Ying Zhang ◽

Xiang Lv ◽

...

Keyword(s):

Intensive Care ◽

Cancer Patients ◽

Intensive Care Units ◽

Critically Ill ◽

Attitude And Practice ◽

Knowledge Attitude And Practice

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Prediction of short- and long-term survival for advanced cancer patients after ICU admission

Supportive Care in Cancer ◽

10.1007/s00520-014-2519-2 ◽

2014 ◽

Vol 23 (6) ◽

pp. 1647-1655 ◽

Cited By ~ 8

Author(s):

Su Jin Heo ◽

Gyuri Kim ◽

Choong-kun Lee ◽

Kyung Soo Chung ◽

Hye Jin Choi ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Term Survival ◽

Long Term Survival ◽

Icu Admission ◽

Short And Long Term

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Epidemiology and clinical characteristics of patients discharged from the ICU in a vegetative or minimally conscious state

PLoS ONE ◽

10.1371/journal.pone.0253225 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0253225

Author(s):

Piotr Knapik ◽

Dawid Borowik ◽

Daniel Cieśla ◽

Ewa Trejnowska

Keyword(s):

Cardiac Arrest ◽

Intensive Care ◽

Intensive Care Units ◽

Craniocerebral Trauma ◽

Minimally Conscious State ◽

Conscious State ◽

Cerebral Stroke ◽

Icu Admission ◽

Icu Discharge ◽

Minimally Conscious

Purpose A significant percentage of patients are discharged from intensive care units (ICU) with disorders of counciousness (DoC). The aim of this retrospective, case-control study was to compare patients discharged from the ICU in a vegetative state (VS) or minimally conscious state (MCS) and the rest of ICU survivors, and to identify independent predictors of DoC among ICU survivors. Methods Data from 14,368 adult ICU survivors identified in a Silesian Registry of Intensive Care Units (active in the Silesian Region of Poland between October 2010 and December 2019) were analyzed. Patients discharged from the ICU in a VS or MCS were compared to the remaining ICU survivors. Pre-admission and admission variables that independently influence ICU discharge with DoC were identified. Results Among the 14,368 analyzed adult ICU survivors, 1,064 (7.4%) were discharged from the ICU in a VS or MCS. The percentage of patients discharged from the ICU with DoC was similar in all age groups. Compared to non- DoC ICU patients, they had a higher mean APACHE II and SAPS III score at admission. Independent variables affecting ICU discharge with DoC included unconsciousness at ICU admission, cardiac arrest and craniocerebral trauma as primary cause of ICU admission, as well as a history of previous chronic neurological disorders and cerebral stroke (p<0.001). Conclusion Discharge in a VS and MCS was relatively frequent among ICU survivors. Discharge with DoC was more likely among patients who were unconscious at admission and admitted to the ICU due to cardiac arrest or craniocerebral trauma.

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Prognostic factors for the short-term mortality of patients with rheumatoid arthritis admitted to intensive care units

10.21203/rs.3.rs-16162/v3 ◽

2020 ◽

Author(s):

Toshifumi Fujiwara ◽

Kentaro Tokuda ◽

Kenta Momii ◽

Kyohei Shiomoto ◽

Hidetoshi Tsushima ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Intensive Care ◽

Prognostic Factors ◽

Intensive Care Units ◽

Fatal Outcome ◽

Laboratory Data ◽

International Normalized Ratio ◽

Apache Ii ◽

Apache Ii Score ◽

Icu Admission

Abstract Background: Patients with rheumatoid arthritis (RA) have high mortality risk and are frequently treated in intensive care units (ICUs). Methods: This was a retrospective observational study. This study included 67 patients (20 males, 47 females) with RA who were admitted at the ICU of our institution for ≥48 h between January 2008 and December 2017. We analyzed the 30-day mortality of these patients and the investigated prognostic factors in RA patients admitted to our ICU.Results: Upon admission, the median age was 70 (range, 33–96) years, and RA duration was 10 (range, 0–61) years. The 5-year survival after ICU admission was 47%, and 30-day, 90-day, and 1-year mortality rates were 22%, 27%, and 37%, respectively. The major reasons for ICU admission were cardiovascular complications (24%) and infection (40%) and the most common ICU treatments were mechanical ventilation (69%), renal replacement (25%), and vasopressor (78%). In the 30-day mortality group, infection led to a fatal outcome in most cases (67%), and nonsurvival was associated with a significantly higher glucocorticoid dose, updated Charlson’s comorbidity index (CCI), and acute physiology and chronic health evaluation (APACHE) II score. Laboratory data obtained at ICU admission showed that lower platelet number and total protein and higher creatinine and prothrombin time international normalized ratio (PT-INR) indicated significantly poorer prognosis. The multivariate Cox proportional hazard model revealed that nonuse of csDMARDs, high updated CCI, increased APACHE II score, and prolonged PT-INR were associated with a higher risk of mortality after ICU admission.Conclusion: Our study demonstrated that the nonuse of csDMARDs, high updated CCI, elevated APACHE II score, and coagulation abnormalities predicted poorer prognosis in RA patients admitted to the ICU.

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Understanding the role of ethnic status in Intensive Care Unit (ICU) deaths among advanced cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2008.26.15_suppl.6506 ◽

2008 ◽

Vol 26 (15_suppl) ◽

pp. 6506-6506 ◽

Cited By ~ 2

Author(s):

E. D. Trice ◽

E. Paulk ◽

M. E. Nilsson ◽

A. A. Wright ◽

T. Balboni ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients

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Priority levels in cancer patients admitted to medical intensive care at a safety net hospital.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18599 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18599-e18599

Author(s):

Raisa Epistola ◽

Michael Olufemi Shodiya ◽

Jordan Epistola ◽

Dong Chang ◽

James Jen-Chi Yeh

Keyword(s):

Intensive Care ◽

Cancer Patients ◽

Critically Ill ◽

Statistical Tests ◽

Quality Care ◽

Safety Net ◽

Close Monitoring ◽

Icu Admission ◽

Safety Net Hospital ◽

Priority Levels

e18599 Background: Admissions of cancer patients to intensive care units (ICU) are increasing with improved mortality. While ICU care can be lifesaving, its higher cost does not always result in reduced mortality. Moreover, timely goals of care (GOC) discussions correlate with less ICU use in those with certain cancers. We investigate if hospital mortality and disposition outcomes for cancer patients correlate to triage by ICU providers. Methods: This subgroup analysis of a prospective cohort of 808 patients admitted to the ICU from 1 July 2015- 15 June 2016 at an academic safety net hospital included 106 patients diagnosed with cancer. Medical records were reviewed by ICU physicians, who assigned priority ranks using Society of Critical Care Medicine guidelines: 1: critically ill, needing treatment/monitoring not provided outside of ICU, 2: not critically ill, but requiring close monitoring/potentially immediate intervention, 3: critically ill patients with reduced likelihood of recovery, 4: not appropriate for ICU, equivalent outcomes achieved with non-ICU care. We did a chart review for factors like prior therapy and documentation of GOC discussions. Statistical tests were conducted to examine if priority levels correlate with disposition, mortality, and length of stay (LOS). Results: χ2-tests revealed priority rank correlated with disposition after hospitalization (p<.05) with group 3 having the highest proportion of deaths and lowest proportion of discharges home. It revealed that mortality rate differed by group (p<.05) with logistic regression showing that priority 3 predicted increased mortality (p<.05). ANCOVA indicated ICU LOS differed by priority group (p<.05), with priority 3 averaging the longest LOS. While priority 3 had the most in-hospital GOC discussions, relatively few were documented pre-hospitalization. Conclusions: Overall, our patients were accurately triaged, with worse mortality and discharge outcomes among priority 3 and a dearth of pre-hospitalization GOC documentation for all groups. Our data show the importance of triaging patients and having early, frequent GOC discussions to minimize ICU admission given increasing demand and costs. GOC discussions are associated with less aggressive medical care near death and better patient quality of life. Thus, holding these talks with our sickest patients prior to potential ICU admission is an area to improve cost-effective high quality care.[Table: see text]

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