Abstract 16331: Prevalence and Outcomes of Arrhythmia in Tumor Lysis Syndrome: A National Perspective

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rupak Desai ◽  
Akhil Jain ◽  
Sandeep Singh ◽  
Mohammed Faisaluddin ◽  
Faizan Ahmad Malik ◽  
...  
Keyword(s):  
Tumor Lysis Syndrome ◽  
Population Based ◽  
Hospital Charges ◽  
Median Length ◽  
Tumor Lysis ◽  
Electrolyte Disturbances ◽  
Life Threatening ◽  
Multivariable Regression ◽  
National Perspective ◽  
Related Mortality

Introduction: Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency. Epidemiology and mortality outcomes of arrhythmia in TLS are scarcely studied in the literature. Methods: We used the National Inpatient Sample (NIS) to study the prevalence and outcome of arrhythmia in patients hospitalized with TLS (ICD-9 code 277.88) from 2009-2014. Multivariable regression was performed to analyze TLS-related mortality. Results: A total of 9034 cases of arrhythmia among 37,861 TLS patients were identified. The trends in the prevalence of arrhythmia were stable with rates ranging from 19.8% to 25.8%, with the highest frequency recorded in 2014 (25.8%) (Fig. 1A). Atrial fibrillation (13.6%) was the most common arrhythmia followed by ventricular tachycardia in 2.6% of the patients (Fig. 1B). Sixty-seven percent of arrhythmias were among white old (>65) males. Arrhythmic cohort showed a higher frequency of comorbidities like fluid-electrolyte disturbances, congestive heart failure, renal failure, pulmonary circulatory disorders, deficiency anemias, etc. The most common malignancies were leukemia and lymphoma. Overall in-hospital mortality (32% vs 21.3%), the median length of stay (11 vs. 9 days) and hospital charges were higher among arrhythmic TLS patients. Conclusions: In this population-based analysis, arrhythmia in TLS was associated with higher odds of mortality and increased resource utilization. Strategies to improve the management of TLS to prevent arrhythmia is of utmost importance.

scholarly journals Fatal Spontaneous Tumor Lysis Syndrome in a Patient with Metastatic Colon Cancer: A Clinical Case of Rare Oncological Emergency

2020 ◽  
Vol 14 (2) ◽  
pp. 255-260
Author(s):  
Inna Shaforostova ◽  
Robert Fiedler ◽  
Martina Zander ◽  
Johannes Pflumm ◽  
Wolfgang Josef März
Keyword(s):  
Colon Cancer ◽  
Case Reports ◽  
Multiorgan Failure ◽  
Tumor Lysis Syndrome ◽  
Metastatic Colon Cancer ◽  
Tumor Lysis ◽  
Oncological Emergency ◽  
Electrolyte Disturbances ◽  
Life Threatening ◽  
Spontaneous Tumor Lysis Syndrome

Tumor lysis syndrome (TLS) is a potentially life-threatening complication of chemotherapy. It usually occurs in rapidly proliferating hematological malignancies. TLS is deemed spontaneous (STLS) when it occurs prior to any cytotoxic or definite treatment. STLS is extremely rare in solid tumors. Here, we report a rare case of fatal STLS in a 47-year-old woman diagnosed with metastatic colon cancer. The patient developed acute renal failure with anuria, electrolyte disturbances, and metabolic acidosis before initiating chemotherapy. Despite appropriate management of TLS, including renal replacement therapy, she died within a few days from multiorgan failure. Only few other case reports of STLS associated with colon cancer have been reported in the literature.

scholarly journals The Domino Effect-Treatment of Superior Vena Cava Obstruction Triggering Tumor Lysis Syndrome: A Case Report

2021 ◽  
Vol 3 (1) ◽  
pp. 44-50
Author(s):  
Suman Ghosh ◽  
Tilak TVSVGK ◽  
Venkatesan Somasundaram ◽  
Mutreja Deepti
Keyword(s):  
Superior Vena Cava ◽  
Lymphoblastic Leukemia ◽  
Superior Vena ◽  
Tumor Lysis Syndrome ◽  
Vena Cava ◽  
Potassium Phosphate ◽  
Successful Outcome ◽  
Superior Vena Cava Obstruction ◽  
Tumor Lysis ◽  
Life Threatening

Oncological emergencies present in a multitude of manners-structural, metabolic, hematologic, etc. affecting multiple systems, often. Urgent institution of therapy is often required for a successful outcome. Occasionally, the treatment of one emergency can initiate a related or unrelated emergency, necessitating management of all the complications simultaneously. Superior vena cava obstruction (SVCO) is a medical emergency and most often manifests in patients with a malignant disease process requiring immediate diagnostic evaluation and therapy due to its’ life threatening presentation. The management of the SVCO is usually with chemotherapy, radiotherapy or intervention. In cases of large tumor burden, management of SVCO can trigger other complications. Tumor lysis syndrome is an oncologic emergency, which is characterized by a massive release of intracellular potassium, phosphate, and nucleic acid metabolites into the systemic circulation, which can be life-threatening. We present the case of a T-cell acute lymphoblastic leukemia with superior vena cava syndrome, developing tumor lysis syndrome on instituting definitive chemotherapy in a young patient. Doi: 10.28991/SciMedJ-2021-0301-6 Full Text: PDF

Hematologic and Oncologic Emergencies

2019 ◽  
pp. 170-177
Author(s):  
James McCue
Keyword(s):  
Emergency Department ◽  
Standardized Tests ◽  
Tumor Lysis Syndrome ◽  
Clinical Effects ◽  
Tumor Lysis ◽  
Oncologic Emergencies ◽  
First Response ◽  
Appropriate Treatment ◽  
Wide Range ◽  
Life Threatening

Hematologic and oncologic emergencies are an uncommon reason for people to present to the emergency department (ED), but when they do, it is important to know how to diagnose and treat these conditions because many of them are life threatening. Whether it is bleeding due to conditions such as hemophilia, von Willebrand’s disease, warfarin use, or dangerous conditions related to cancer such as tumor lysis syndrome or neutropenic fever, knowing the basics will help you manage these patients and also ace the standardized tests. This chapter presents questions related to the diagnosis, clinical effects, best first response in the ED, and most appropriate treatment of a wide range of these hematologic and oncologic emergencies.

scholarly journals Prevention and Treatment of Tumor Lysis Syndrome in the Era of Onco-Nephrology Progress

2020 ◽  
Vol 45 (5) ◽  
pp. 645-660
Author(s):  
Joanna Matuszkiewicz-Rowinska ◽  
Jolanta Malyszko
Keyword(s):  
High Risk ◽  
Treatment Plan ◽  
Diuretic Therapy ◽  
Tumor Lysis Syndrome ◽  
Phosphate Binders ◽  
Tumor Lysis ◽  
Threatening Condition ◽  
Clinical Consequences ◽  
Life Threatening ◽  
Knowledge Of Cancer

Background: Tumor lysis syndrome (TLS) is an oncologic emergency due to a rapid break down of malignant cells usually induced by cytotoxic therapy, with hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and serious clinical consequences such as acute renal injury, cardiac arrhythmia, hypotension, and death. Rapidly expanding knowledge of cancer immune evasion mechanisms and host-tumor interactions has significantly changed our therapeutic strategies in hemato-oncology what resulted in the expanding spectrum of neoplasms with a risk of TLS. Summary: Since clinical TLS is a life-threatening condition, identifying patients with risk factors for TLS development and implementation of adequate preventive measures remains the most critical component of its medical management. In general, these consist of vigilant laboratory and clinical monitoring, vigorous IV hydration, urate-lowering therapy, avoidance of exogenous potassium, use of phosphate binders, and – in high-risk cases – considering cytoreduction before the start of the aggressive agent or a gradual escalation of its dose. Key Messages: In patients with a high risk of TLS, cytotoxic chemotherapy should be given in the facility with ready access to dialysis and a treatment plan discussed with the nephrology team. In the case of hyperkalemia, severe hyperphosphatemia or acidosis, and fluid overload unresponsive to diuretic therapy, the early renal replacement therapy (RRT) should be considered. One must remember that in TLS, the threshold for RRT initiation may be lower than in other clinical situations since the process of cell breakdown is ongoing, and rapid increases in serum electrolytes cannot be predicted.

scholarly journals Hyperleucocytosis in children with acute mieloid leukemia

2020 ◽  
Vol 19 (1) ◽  
pp. 116-121
Author(s):  
N. V. Zacharov ◽  
I. I. Kalinina ◽  
D. A. Venev ◽  
T. Y. Salimova ◽  
D. A. Evseev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tumor Lysis Syndrome ◽  
Blood Transfusions ◽  
Review Of The Literature ◽  
Specific Therapy ◽  
Important Place ◽  
Tumor Lysis ◽  
Life Threatening

This article presents analysis of recent publications on hyperleukocytosis in children with AML. The mechanisms of the development of life-threatening complications accompanying hyperleukocytosis are analyzed in detail. In this review of the literature, the authors focus on the adequacy and timing of therapy for such life-threatening complications of hyperleukocytosis as leukostasis, DIC, and acute tumor lysis syndrome. The authors emphasize that in the treatment of hyperleukocytosis an important place, in addition to specific therapy, is taken by the accompanying therapy in the intensive care unit. The place of replacement blood transfusions and leukopheresis as part of the accompanying therapy is discussed.

scholarly journals Interrelationship of Electrolyte and Vitamins Profile in Patients Experiencing Tumor Lysis Syndrome

2021 ◽  
Vol 15 (7) ◽  
pp. 1597-1599
Author(s):  
Khadija Mastoor ◽  
Bushra Suhail ◽  
Asma Inam ◽  
Nada Azam ◽  
Maria Amjad ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Tumor Lysis Syndrome ◽  
Elevated Serum ◽  
Serum Levels ◽  
Prospective Clinical Study ◽  
Metabolic Derangement ◽  
Tumor Lysis ◽  
Normal Individuals ◽  
Life Threatening ◽  
Older Cancer Patients

Background:Tumor lysis syndrome is a metabolic derangement which is seen in patients with malignancy and receiving drugs for cancer treatment. It can arise in children or older cancer patients and is considered life threatening. Anticancer drug therapy is most commonly used method to treat cancer. Aim: To investigate the role of electrolytes and vitamins (A, C and E) in cancer patients suffering from tumor lysis syndrome during anticancer therapy. Study design: Prospective clinical study Methods: The study enrolled fifty diagnosed patients of Tumor lysis syndrome.Informed consent was taken from patients.Twenty patients, clinically healthy, age and sex-matched were selected as a control in the present study. 5cc blood was withdrawn from enrolled cases. The obtained samples were centrifuged at the speed of 4000-5000rpm for 10-15 minutes to obtain serum. The levels of Electrolytes (Na+, K+), and Vitamins A, C, E were estimated. Results: Study showed elevated serum levels of sodium (Na+) (28.26) in comparison withcontrol normal persons (21.26) and this is significant statistically (0.02<0.05). Serum Potassium levels among Tumor lysis syndrome (TLS) cases was (13.26) as observed in normal controlled persons (14.26) and results were significant statistically (0.03<0.05). Vitamin A level in Tumor lysis syndrome(TLS) cases decreased outstandingly (102.20) in contrast to normal control study persons.(188.26) and this is significant statistically (0.026<0.05). The values for Vitamin E in Tumor lysis syndrome cases was (4.26) and in controlled normal individuals (7.26) and proved significant statistically (0.015<0.05). Conclusion: Present study showed inverse relationship between Vitamins and electrolytes in TLS. Increased level of electrolyte imbalances and decreased vitamin levels is the reason responsible for the development of tumor lysis syndrome. Keywords: TLS, Vit A, Vit C, Vit E, Na+,K+

scholarly journals Crisis management in the treatment of childhood acute lymphoblastic leukemia: putting right what can go wrong (emergency complications of disease and treatment)

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 251-258 ◽  
Author(s):  
Rachael Hough ◽  
Ajay Vora
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Tumor Lysis Syndrome ◽  
Treatment Delays ◽  
Life Threatening ◽  
Pediatric All ◽  
Short And Long Term ◽  
Dose Reductions ◽  
Related Mortality

AbstractThe improvement in overall survival in children with acute lymphoblastic leukemia (ALL) over the last 5 decades has been considerable, with around 90% now surviving long term. The risk of relapse has been reduced to such an extent that the risk of treatment-related mortality is now approaching that of mortality caused by relapse. Toxicities may also lead to the suboptimal delivery of chemotherapy (treatment delays, dose reductions, dose omissions), potentially increasing relapse risk, and short- and long-term morbidity, adding to the “burden of therapy” in an increasing number of survivors. Thus, the need to reduce toxicity in pediatric ALL is becoming increasingly important. This work focuses on the risk factors, pathogenesis, clinical features, and emergency management of the life-threatening complications of ALL at presentation and during subsequent chemotherapy, including leucostasis, tumor lysis syndrome, infection, methotrexate encephalopathy, thrombosis, and pancreatitis. Potential strategies to abrogate these toxicities in the future are also discussed.

Healthcare utilization and outcomes in HIV versus non-HIV patients with anal cancer: A nationwide analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15505-e15505
Author(s):  
Ikechukwu Achebe ◽  
Jennifer C Asotibe ◽  
Syed Ali Amir Sherazi ◽  
Okechukwu Obi ◽  
Bashar Attar ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Anal Cancer ◽  
Protein Energy Malnutrition ◽  
Tumor Lysis Syndrome ◽  
Kidney Injury ◽  
Hospital Charges ◽  
Teaching Hospitals ◽  
National Database ◽  
Inpatient Mortality ◽  
Tumor Lysis

e15505 Background: Anal cancer (AC) is the most common HPV-associated cancer in men with HIV. Nearly one third of men with anal cancer have HIV with HPV accounting for 88% of cases. Studies have reported mixed outcomes in HIV-Anal Cancer (HIV-AC) compared to non-HIV-AC patients with most studies being small and retrospective. There were no clear explanations for the differences in the outcomes in both groups. We studied HIV-AC patients from a national database and compared the outcomes and healthcare utilization with non-HIV AC cohort. Methods: We identified all adult patients with AC, with and without HIV, between 2016-2018 from the Healthcare Cost Utilization Project (HCUP) National Inpatient Sample (NIS) database. The groups were compared for socio-demographic differences, inpatient mortality, length of stay (LOS) and total hospital charges (THC). Secondary outcomes studied were rate of acute kidney injury (AKI), tumor lysis syndrome (TLS), lower GI Bleed (LGIB), anemia, tumor lysis (TLS), sepsis, septic shock (SS), neutropenia and protein energy malnutrition (PEM). Statistics was performed using the t-test, univariate and multivariate logistic regression using Stata software. Results: A total of 1235 inpatient admissions with HIV-AC and 10,415 with non-HIV-AC were identified. HIV-AC patients were significantly younger (mean age 50.2 vs 63 years, p < 0.0001) with few over 65 years (8% vs 44.2%, p < 0.0001), more men (82.6% vs 30.8%, p < 0.001), more likely African Americans (AA) (47.8% VS 11.2%, p < 0.0001) and significantly more likely to be treated at a teaching hospital (90.7% vs 9.3%, p < 0.0001) compared to non-HIV-AC cohort. HIV-AC patients had significantly lower odds of inpatient mortality (aOR= 0.26, CI = 0.093 – 0.705, p = 0.008) but higher LOS (7.4 vs 6.5 days, p = 0.02) and higher THC ($74,131 vs $60,864, p = 0.005). Rates of sepsis were higher in HIV-AC (OR = 2.11, CI = 1.465 - 3.028, p < 0.0001) compared to non-HIV-AC, but odds of AKI, TLS, LGIB, SS, anemia, neutropenia and PEM were similar. Conclusions: HIV-AC patients are more likely to be younger, AA, men and have significantly lower inpatient mortality compared to non-HIV-AC, despite higher rates of sepsis. HIV-AC patients being younger and overwhelmingly (90%) treated at teaching hospitals may be contributing to the observed lower mortality. However, the HIV-AC cohort was also a high inpatient healthcare utilizer with significantly increased hospital charges amounting to over $16 million over 3 years. The reversal of sex incidence likely reflects the different exposure to HPV in HIV and non-HIV cohorts. Prospective studies are needed to further evaluate outcomes in HIV-AC patients and identify underlying contributors of higher utilization.

Financial Impact of Tumor Lysis Syndrome Among Inpatients in the United States

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5966-5966
Author(s):  
Ranjan Pathak ◽  
Smith Giri ◽  
Madan Raj Aryal ◽  
Paras Karmacharya ◽  
Vijaya R. Bhatt ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Nationwide Inpatient Sample ◽  
Tumor Lysis Syndrome ◽  
The United States ◽  
Hospital Charge ◽  
Hospital Charges ◽  
Tumor Lysis ◽  
Significant Difference ◽  
The Us ◽  
The Mean

Abstract Background With an estimated 0.1 million cases in 2014, lymphomas and acute leukemias are the leading causes of malignancies in the US. Tumor lysis syndrome (TLS) is a potentially devastating complication associated with hematologic malignancies leading to increased morbidity and mortality. Previous European studies have shown that the financial burden of TLS is high, with an estimated cost of 7,342 Euros ($10,320 US Dollars) per admission. However, there is a paucity of data on the economic impact of TLS among US inpatients. Methods We used the Nationwide Inpatient Sample database to identify hospitalized patients aged ≥18 years with a primary diagnosis of TLS (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 277.88) from the first year the diagnosis code was introduced (2009) to 2011. Nationwide Inpatient Sample is the largest all-payer publicly available inpatient care database in the US. It contains data from five to eight million hospital stays from about 1,000 hospitals across the country and approximates a 20% sample of all US hospitals. We calculated the mean length of stay (LOS) and mean hospital charges per TLS admission and compared them with those of overall inpatient admissions. Given that renal failure occurs in severe cases, we compared the mean LOS and hospital charge between TLS patients with and without RRT (hemodialysis or peritoneal dialysis, ICD-9-CM procedure codes 39.35 and 54.98 respectively). Data analysis was done using STATA version 13.0 (College Station, TX). Results We identified 997 admissions with TLS. Mean age was 67.5 (±3.3) with 62% males and 80.4% whites. Overall mean LOS and hospital charge for TLS during the study period was 8.02 days (SE 0.83) and $ 72,840 (SE 8,083). Both the mean LOS and hospital charge for TLS were significantly higher than overall in-patient admissions (Table 1). A total of 949 patients (95%) underwent RRT. There was no significant difference in mean LOS (9.84 days vs 7.94 days, p=0.28) and mean hospital charge ($ 88,098 vs $ 71,930, p=0.58) in patients with TLS that underwent RRT compared (95.2%, n=949) to patients that did not undergo RRT (4.8%, n=48). Conclusion Our study shows that TLS is associated with a significant economic burden, with a mean cost of $ 72,840 per TLS hospitalization. Although majority of the patients hospitalized for TLS received RRT, its use was not associated with significantly higher costs. Further studies are warranted to determine the ways of optimizing current preventive measures and to explore the drivers of increased in-hospital costs in TLS patients. Table 1 Mean LOS and Hospital Charge in TLS Admissions Compared with Overall Inpatient Admissions, 2009-2011 Year Mean LOS (days) Mean hospital charge (USD) TLS admissions Overall admissions p TLS admissions Overall admissions p 2009 13.94 4.5 0.02 104,235 30,506 0.04 2010 7.62 4.6 <0.001 69,552 32,799 <0.001 2011 7.14 4.5 <0.001 69,222 35,213 <0.001 LOS=Length of Stay; TLS=Tumor Lysis Syndrome; USD=US Dollars Disclosures No relevant conflicts of interest to declare.

Common Electrolyte Imbalances Associated with Malignancy

1992 ◽  
Vol 3 (3) ◽  
pp. 714-723 ◽  
Author(s):  
Jan L. Hawthorne ◽  
Susan M. Schneider ◽  
M. Linda Workman
Keyword(s):  
Critical Care ◽  
Survival Time ◽  
Malignant Disease ◽  
Tumor Lysis Syndrome ◽  
Critical Care Nurses ◽  
Term Survival ◽  
Tumor Lysis ◽  
Critical Care Units ◽  
Life Threatening

More than one million Americans will be diagnosed with cancer during 1992, and 50% will be cured of their disease. Of those individuals not cured of the malignancy, survival time after diagnosis has increased tremendously compared to 1980. Because of advances in therapy and the increase in long-term survival, the presence of cancer patients in critical care units should no longer represent either a medical contradiction or an ethical dilemma when the condition requiring critical care is potentially reversible. Many of these individuals may become patients in critical care settings as a result of specific electrolyte imbalances caused by the malignant disease or treatment of malignancy. Although the imbalances often are temporary, they can be life-threatening without intervention. The most common temporary electrolyte imbalances associated with malignant conditions are hypercalcemia, hyperkalemia, and tumor lysis syndrome. Critical care nurses can contribute skill and knowledge in ameliorating these conditions so that the person with cancer can have better quality and longer survival time

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