Journal
INTENSIVE CARE MEDICINE
Volume 47, Issue 2, Pages 170-179Publisher
SPRINGER
DOI: 10.1007/s00134-020-06184-2
Keywords
Cancer; Mortality trends; Critical care; Multicenter study; Bayesian analysis
Categories
Funding
- National Council for Scientific and Technological Development (CNPq) [302188/2018-5]
- Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ)
- D'Or Institute for Research and Education
Ask authors/readers for more resources
Outcomes of critically ill cancer patients have improved over the past 8 years, with reductions in both mortality and ICU length of stay, indicating overall care improvements. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised performance status.
Purpose To describe trends in outcomes of cancer patients with unplanned admissions to intensive-care units (ICU) according to cancer type, organ support use, and performance status (PS) over an 8-year period. Methods We retrospectively analyzed prospectively collected data from all cancer patients admitted to 92 medical-surgical ICUs from July/2011 to June/2019. We assessed trends in mortality through a Bayesian hierarchical model adjusted for relevant clinical confounders and whether there was a reduction in ICU length-of-stay (LOS) over time using a competing risk model. Results 32,096 patients (8.7% of all ICU admissions; solid tumors, 90%; hematological malignancies, 10%) were studied. Bed/days use by cancer patients increased up to more than 30% during the period. Overall adjusted mortality decreased by 9.2% [95% credible interval (CI), 13.1-5.6%]. The largest reductions in mortality occurred in patients without need for organ support (9.6%) and in those with need for mechanical ventilation (MV) only (11%). Smallest reductions occurred in patients requiring MV, vasopressors, and dialysis (3.9%) simultaneously. Survival gains over time decreased as PS worsened. Lung cancer patients had the lowest decrease in mortality. Each year was associated with a lower sub-hazard for ICU death [SHR 0.93 (0.91-0.94)] and a higher chance of being discharged alive from the ICU earlier [SHR 1.01 (1-1.01)]. Conclusion Outcomes in critically ill cancer patients improved in the past 8 years, with reductions in both mortality and ICU LOS, suggesting improvements in overall care. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised PS.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available