Factors associated with survival of patients with solid Cancer alive after intensive care unit discharge between 2005 and 2013

Abstract Background At intensive care unit (ICU) admission, the issue about prognosis of critically ill cancer patients is of clinical interest, especially after ICU discharge. Our objective was to assess the factors associated with 3- and 6-month survival of ICU cancer survivors. Methods Based on the French OutcomeRea™ database, we included solid cancer patients discharged alive, between December 2005 and November 2013, from the medical ICU of the university hospital in Grenoble, France. Patient characteristics and outcome at 3 and 6 months following ICU discharge were extracted from available database. Results Of the 361 cancer patients with unscheduled admissions, 253 (70%) were discharged alive from ICU. The main primary cancer sites were digestive (31%) and thoracic (26%). The 3- and 6-month mortality rates were 33 and 41%, respectively. Factors independently associated with 6-month mortality included ECOG performance status (ECOG-PS) of 3–4 (OR,3.74; 95%CI: 1.67–8.37), metastatic disease (OR,2.56; 95%CI: 1.34–4.90), admission for cancer progression (OR,2.31; 95%CI: 1.14–4.68), SAPS II of 45 to 58 (OR,4.19; 95%CI: 1.76–9.97), and treatment limitation decision at ICU admission (OR,4.00; 95%CI: 1.64–9.77). Interestingly, previous cancer chemotherapy prior to ICU admission was independently associated with lower 3-month mortality (OR, 0.38; 95%CI: 0.19–0.75). Among patients with an ECOG-PS 0–1 at admission, 70% (n = 66) and 61% (n = 57) displayed an ECOG-PS 0–2 at 3- and 6-months, respectively. At 3 months, 74 (55%) patients received anticancer treatment, 13 (8%) were given exclusive palliative care. Conclusions Factors associated with 6-month mortality are almost the same as those known to be associated with ICU mortality. We highlight that most patients recovered an ECOG-PS of 0–2 at 3 and 6 months, in particular those with a good ECOG-PS at ICU admission and could benefit from an anticancer treatment following ICU discharge.

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Selection criteria for intensive care unit referral of lung cancer patients: a pilot study

European Respiratory Journal ◽

10.1183/09031936.00118114 ◽

2014 ◽

Vol 45 (2) ◽

pp. 491-500 ◽

Cited By ~ 19

Author(s):

Anne-Claire Toffart ◽

Carola Alegria Pizarro ◽

Carole Schwebel ◽

Linda Sakhri ◽

Clemence Minet ◽

...

Keyword(s):

Lung Cancer ◽

Intensive Care Unit ◽

Intensive Care ◽

Cancer Patients ◽

Selection Criteria ◽

Performance Status ◽

Lung Cancer Patients ◽

Icu Admission ◽

Organ Failures ◽

Intensity Of Care

The decision-making process for the intensity of care delivered to patients with lung cancer and organ failure is poorly understood, and does not always involve intensivists. Our objective was to describe the potential suitability for intensive care unit (ICU) referral of lung cancer in-patients with organ failures.We prospectively included consecutive lung cancer patients with failure of at least one organ admitted to the teaching hospital in Grenoble, France, between December 2010 and October 2012.Of 140 patients, 121 (86%) were evaluated by an oncologist and 49 (35%) were referred for ICU admission, with subsequent admission for 36 (73%) out of those 49. Factors independently associated with ICU referral were performance status ⩽2 (OR 10.07, 95% CI 3.85–26.32), nonprogressive malignancy (OR 7.00, 95% CI 2.24–21.80), and no explicit refusal of ICU admission by the patient and/or family (OR 7.95, 95% CI 2.39–26.37). Factors independently associated with ICU admission were the initial ward being other than the lung cancer unit (OR 6.02, 95% CI 1.11–32.80) and an available medical ICU bed (OR 8.19, 95% CI 1.48–45.35).Only one-third of lung cancer patients with organ failures were referred for ICU admission. The decision not to consider ICU admission was often taken by a non-intensivist, with advice from an oncologist rather than an intensivist.

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Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.2.761 ◽

1998 ◽

Vol 16 (2) ◽

pp. 761-770 ◽

Cited By ~ 162

Author(s):

J S Groeger ◽

S Lemeshow ◽

K Price ◽

D M Nierman ◽

P White ◽

...

Keyword(s):

Intensive Care Unit ◽

Logistic Regression ◽

Intensive Care ◽

Hospital Mortality ◽

Cancer Patients ◽

The United States ◽

Categorical Variables ◽

Allogeneic Bone ◽

Icu Admission ◽

Hospital Survival

PURPOSE To develop prospectively and validate a model for probability of hospital survival at admission to the intensive care unit (ICU) of patients with malignancy. PATIENTS AND METHODS This was an inception cohort study in the setting of four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU. A preliminary model was developed from 1,483 patients and then validated on an additional 230 patients. Multiple logistic regression modeling was used to develop the models and subsequently evaluated by goodness-of-fit and receiver operating characteristic (ROC) analysis. The main outcome measure was hospital survival after ICU admission. RESULTS The observed hospital mortality rate was 42%. Continuous variables used in the ICU admission model are PaO2/FiO2 ratio, platelet count, respiratory rate, systolic blood pressure, and days of hospitalization pre-ICU. Categorical entries include presence of intracranial mass effect, allogeneic bone marrow transplantation, recurrent or progressive cancer, albumin less than 2.5 g/dL, bilirubin > or = 2 mg/dL, Glasgow Coma Score less than 6, prothrombin time greater than 15 seconds, blood urea nitrogen (BUN) greater than 50 mg/dL, intubation, performance status before hospitalization, and cardiopulmonary resuscitation (CPR). The P values for the fit of the preliminary and validation models are .939 and .314, respectively, and the areas under the ROC curves are .812 and .802. CONCLUSION We report a disease-specific multivariable logistic regression model to estimate the probability of hospital mortality in a cohort of critically ill cancer patients admitted to the ICU. The model consists of 16 unambiguous and readily available variables. This model should move the discussion regarding appropriate use of ICU resources forward. Additional validation in a community hospital setting is warranted.

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Quantifying Physical Activity Levels of Survivors of Intensive Care: A Prospective Observational Study

Physical Therapy ◽

10.2522/ptj.20110411 ◽

2012 ◽

Vol 92 (12) ◽

pp. 1507-1517 ◽

Cited By ~ 17

Author(s):

Linda Denehy ◽

Sue Berney ◽

Laura Whitburn ◽

Lara Edbrooke

Keyword(s):

Physical Activity ◽

Intensive Care ◽

Interquartile Range ◽

Apache Ii Score ◽

Activity Levels ◽

Free Living ◽

Factors Associated ◽

Icu Admission ◽

Icu Discharge ◽

Physical Activity Levels

Background Promotion of increased physical activity is advocated for survivors of an intensive care unit (ICU) admission to improve physical function and health-related quality of life. Objective The primary aims of this study were: (1) to measure free-living physical activity levels and (2) to correlate the measurements with scores on a self-reported activity questionnaire. A secondary aim was to explore factors associated with physical activity levels. Design This was a prospective cohort study. Methods Nested within a larger randomized controlled trial, participants were block randomized to measure free-living physical activity levels. Included participants wore an accelerometer for 7 days during waking hours at 2 months after ICU discharge. At completion of the 7 days of monitoring, participants were interviewed using the Physical Activity Scale for the Elderly (PASE) questionnaire. Factors associated with physical activity were explored using regression analysis. Results The ICU survivors (median age=59 years, interquartile range=49–66; mean Acute Physiologic Chronic Health Evaluation [APACHE II] score=18, interquartile range=16–21) were inactive when quantitatively measured at 2 months after hospital discharge. Participants spent an average of 90% of the time inactive and only 3% of the time walking. Only 37% of the sample spent 30 minutes or more per day in the locomotion category (more than 20 steps in a row). Activity reported using the PASE questionnaire was lower than that reported in adults who were healthy. The PASE scores correlated only fairly with activity measured by steps per day. The presence of comorbidities explained one third of the variance in physical activity levels. Limitations Accelerometer overreading, patient heterogeneity, selection bias, and sample size not reached were limitations of the study. Conclusions Survivors of an ICU admission greater than 5 days demonstrated high levels of inactivity for prolonged periods at 2 months after ICU discharge, and the majority did not meet international recommendations regarding physical activity. Comorbidity appears to be a promising factor associated with activity levels.

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Risk Factors Associated With Resistance to Ciprofloxacin in Clinical Bacterial Isolates From Intensive Care Unit Patients

Infection Control and Hospital Epidemiology ◽

10.1086/511701 ◽

2007 ◽

Vol 28 (3) ◽

pp. 331-336 ◽

Cited By ~ 10

Author(s):

Phillip D. Levin ◽

Robert A. Fowler ◽

Cameron Guest ◽

William J. Sibbald ◽

Alex Kiss ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Prior Treatment ◽

Bacterial Isolates ◽

Icu Patients ◽

Gram Negative ◽

Factors Associated ◽

Icu Admission ◽

Ciprofloxacin Resistance

Objective.To determine risk factors and outcomes associated with ciprofloxacin resistance in clinical bacterial isolates from intensive care unit (ICU) patients.Design.Prospective cohort study.Setting.Twenty-bed medical-surgical ICU in a Canadian tertiary care teaching hospital.Patients.All patients admitted to the ICU with a stay of at least 72 hours between January 1 and December 31, 2003.Methods.Prospective surveillance to determine patient comorbidities, use of medical devices, nosocomial infections, use of antimicrobials, and outcomes. Characteristics of patients with a ciprofloxacin-resistant gram-negative bacterial organism were compared with characteristics of patients without these pathogens.Results.Ciprofloxacin-resistant organisms were recovered from 20 (6%) of 338 ICU patients, representing 38 (21%) of 178 nonduplicate isolates of gram-negative bacilli. Forty-nine percent ofPseudomonas aeruginosaisolates and 29% ofEscherichia coliisolates were resistant to ciprofloxacin. In a multivariate analysis, independent risk factors associated with the recovery of a ciprofloxacin-resistant organism included duration of prior treatment with ciprofloxacin (relative risk [RR], 1.15 per day [95% confidence interval {CI}, 1.08-1.23];P< .001), duration of prior treatment with levofloxacin (RR, 1.39 per day [95% CI, 1.01-1.91];P= .04), and length of hospital stay prior to ICU admission (RR, 1.02 per day [95% CI, 1.01-1.03];P= .005). Neither ICU mortality (15% of patients with a ciprofloxacin-resistant isolate vs 23% of patients with a ciprofloxacin-susceptible isolate;P= .58 ) nor in-hospital mortality (30% vs 34%;P= .81 ) were statistically significantly associated with ciprofloxacin resistance.Conclusions.ICU patients are at risk of developing infections due to ciprofloxacin-resistant organisms. Variables associated with ciprofloxacin resistance include prior use of fluoroquinolones and duration of hospitalization prior to ICU admission. Recognition of these risk factors may influence antibiotic treatment decisions.

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Factors Associated With Rapid Response Call Conversion To Code Blue Or Intensive Care Unit (ICU) Admission

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6579 ◽

2012 ◽

Author(s):

Jennifer Maguire ◽

Shannon S. Carson ◽

Loc Culp ◽

Celeste Mayer ◽

Renae E. Stafford ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Rapid Response ◽

Factors Associated ◽

Icu Admission ◽

Code Blue

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Survival in solid cancer patients following intensive care unit admission

Intensive Care Medicine ◽

10.1007/s00134-014-3471-9 ◽

2014 ◽

Vol 40 (10) ◽

pp. 1409-1428 ◽

Cited By ~ 73

Author(s):

Kathryn Puxty ◽

Philip McLoone ◽

Tara Quasim ◽

John Kinsella ◽

David Morrison

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Cancer Patients ◽

Solid Cancer

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Weaning outcome of solid cancer patients requiring mechanical ventilation in the intensive care unit

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2019.02.007 ◽

2019 ◽

Vol 118 (6) ◽

pp. 995-1004 ◽

Cited By ~ 4

Author(s):

Emily Han-Chung Hsiue ◽

Pei-Lin Lee ◽

Yung-Hsuan Chen ◽

Ting-Hui Wu ◽

Chiao-Feng Cheng ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Cancer Patients ◽

Solid Cancer ◽

Weaning Outcome

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Value of Performing Active Surveillance Cultures on Intensive Care Unit Discharge for Detection of Methicillin-ResistantStaphylococcus aureus

Infection Control and Hospital Epidemiology ◽

10.1086/518348 ◽

2007 ◽

Vol 28 (6) ◽

pp. 666-670 ◽

Cited By ~ 21

Author(s):

Jon P. Furuno ◽

Anthony D. Harris ◽

Marc-Oliver Wright ◽

David M. Hartley ◽

Jessina C. McGregor ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Active Surveillance ◽

Tertiary Care ◽

Large Percentage ◽

Care Hospital ◽

Icu Admission ◽

Surveillance Cultures ◽

Icu Discharge ◽

Mrsa Colonization

Objective.To quantify the value of performing active surveillance cultures for detection of methicillin-resistantStaphylococcus aureus(MRSA) on intensive care unit (ICU) discharge.Design.Prospective cohort study.Setting.Medical ICU (MICU) and surgical ICU (SICU) of a tertiary care hospital.Participants.We analyzed data on adult patients who were admitted to the MICU or SICU between January 17, 2001, and December 31, 2004. All participants had a length of ICU stay of at least 48 hours and had surveillance cultures of anterior nares specimens performed on ICU admission and discharge. Patients who had MRSA-positive clinical cultures in the ICU were excluded.Results.Of 2,918 eligible patients, 178 (6%) were colonized with MRSA on ICU admission, and 65 (2%) acquired MRSA in the ICU and were identified by results of discharge surveillance cultures. Patients with MRSA colonization confirmed by results of discharge cultures spent 853 days in non-ICU wards after ICU discharge, which represented 27% of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.Conclusions.Surveillance cultures of nares specimens collected at ICU discharge identified a large percentage of MRSA-colonized patients who would not have been identified on the basis of results of clinical cultures or admission surveillance cultures alone. Furthermore, these patients were responsible for a large percentage of the total number of MRSA colonization-days during hospitalization in non-ICU wards for patients discharged from the ICU.

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Usefulness of oxidative stress marker evaluation at admission to the intensive care unit in patients with COVID-19

Journal of International Medical Research ◽

10.1177/03000605211027733 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110277

Author(s):

Hayrettin Daskaya ◽

Sinan Yilmaz ◽

Harun Uysal ◽

Muhittin Calim ◽

Bilge Sümbül ◽

...

Keyword(s):

Oxidative Stress ◽

Intensive Care Unit ◽

Intensive Care ◽

Clinical Severity ◽

Oxidative Stress Marker ◽

Icu Admission ◽

Stress Marker ◽

Icu Discharge ◽

Discharge Status ◽

Marker Status

Objective Two critical processes in the coronavirus disease 2019 (COVID-19) pandemic involve assessing patients’ intensive care needs and predicting disease progression during patients’ intensive care unit (ICU) stay. We aimed to evaluate oxidative stress marker status at ICU admission and ICU discharge status in patients with COVID-19. Methods We included patients in a tertiary referral center ICU during June–December 2020. Scores of Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and clinical severity, radiologic scores, and healthy discharge status were noted. We collected peripheral blood samples at ICU admission to evaluate total antioxidants, total oxidants, catalase, and myeloperoxidase levels. Results Thirty-one (24 male, 7 female) patients were included. At ICU admission, patients’ mean APACHE II score at ICU admission was 17.61 ± 8.9; the mean SOFA score was 6.29 ± 3.16. There was no significant relationship between clinical severity and oxidative stress (OS) markers nor between radiological imaging and COVID-19 data classification and OS levels. Differences in OS levels between patients with healthy and exitus discharge status were not significant. Conclusions We found no significant relationship between oxidative stress marker status in patients with COVID-19 at ICU admission and patients’ ICU discharge status.

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