Risk factors to predict outcome in critically ill cancer patients receiving chemotherapy in the intensive care unit

Abstract

Objective: The decision to start chemotherapy in critically ill cancer patients is extremely complex in the intensive care unit (ICU). Therefore, this study evaluated the outcomes and prognostic factors in critically ill cancer patients receiving chemotherapy in the ICU.

Methods: A retrospective analysis was performed using 62 cancer patients who received chemotherapy in the ICU between October 2002 and December 2008. The dataset included 49 hematologic malignancies (79%) and 13 solid tumors (21%).

Results: Twenty (32%) patients were admitted to the ICU with septic shock, 15 (24%) with respiratory failure, and 14 (23%) with renal failure. The median SOFA and SAPS II scores at the time of chemotherapy were 10 (interquartile range, 6-14) and 53 (interquartile range, 41-68), respectively. Twenty-three (37%) patients had concomitant infections when chemotherapy was initiated. Thirty-eight (61%) patients received mechanical ventilation, and 19 (31%) patients underwent renal replacement therapy at the moment of chemotherapy. Overall, 25 (40%) patients died in the ICU; death occurred due to septic shock (13, 52%), cancer progression (9, 36%), or bleeding (2, 8%). ICU mortality after chemotherapy was correlated with respiratory failure requiring mechanical ventilation (OR, 6.26; 95% CI, 1.12-34.95) and a SOFA score of ≥10 (OR, 9.66; 95% CI, 1.43-65.47) upon initiating chemotherapy.

Conclusions: Chemotherapy in the ICU for critically ill cancer patients can be considered even when infection or organ failure is present. However, the severity of organ failure, including respiratory failure requiring mechanical ventilation, was associated with an increased mortality after chemotherapy during an ICU stay.