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. 2017 Jul 27;12(7):e0181808.
doi: 10.1371/journal.pone.0181808. eCollection 2017.

Respiratory events in ward are associated with later intensive care unit (ICU) admission and hospital mortality in onco-hematology patients not admitted to ICU after a first request

Laure Doukhan  1 , Magali Bisbal  1 , Laurent Chow-Chine  1 , Antoine Sannini  1 , Jean Paul Brun  1 , Sylvie Cambon  1 , Lam Nguyen Duong  1 , Marion Faucher  1 , Djamel Mokart  1
Affiliations

Respiratory events in ward are associated with later intensive care unit (ICU) admission and hospital mortality in onco-hematology patients not admitted to ICU after a first request

Laure Doukhan et al. PLoS One. .

Abstract

Introduction: Prognostic impact of delayed intensive care unit(ICU) admission in critically ill cancer patients remains debatable. We determined predictive factors for later ICU admission and mortality in cancer patients initially not admitted after their first ICU request.

Methods: All cancer patients referred for an emergency ICU admission between 1 January 2012 and 31 August 2013 were included.

Results: Totally, 246(54.8%) patients were immediately admitted. Among 203(45.2%) patients denied at the first request, 54(26.6%) were admitted later. A former ICU stay [OR: 2.75(1.12-6.75)], a request based on a clinical respiratory event[OR: 2.6(1.35-5.02)] and neutropenia[OR: 2.25(1.06-4.8)] were independently associated with later ICU admission. Survival of patients admitted immediately and later did not differ at ICU(78.5% and 70.4%, respectively; p = 0.2) or hospital(74% and 66%, respectively; p = 0.24) discharge. Hospital mortality of patients initially not admitted was 29.7% and independently associated with malignancy progression[OR: 3.15(1.6-6.19)], allogeneic hematopoietic stem cell transplantation[OR: 2.5(1.06-5.89)], a request based on a clinical respiratory event[OR: 2.36(1.22-4.56)] and severe sepsis[OR: 0.27(0.08-0.99)].

Conclusion: Compared with immediate ICU admission, later ICU admission was not associated with hospital mortality. Clinical respiratory events were independently associated with both later ICU admission and hospital mortality.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart.
1 Multiple requests for a same patient: only the first was analysed. 2 Multiple ICU stays for a same patient: only the first was analysed.
Fig 2
Fig 2. Kaplan-Meier survival curves of « immediate admission » and « later admission » groups.
Fig 3
Fig 3. Kaplan-Meier survival curves of patients presenting a respiratory event and no respiratory event.
See this image and copyright information in PMC

References

    1. Young MP, Gooder VJ, McBride K, James B, Fisher ES. Inpatient transfers to the intensive care unit: delays are associated with increased mortality and morbidity. J Gen Intern Med 2003: 18(2):77–83. doi: 10.1046/j.1525-1497.2003.20441.x - DOI - PMC - PubMed
    1. Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med 2011: 365(2):139–146. doi: 10.1056/NEJMra0910926 - DOI - PubMed
    1. Thiery G, Azoulay E, Darmon M, Ciroldi M, de MS, Levy V et al. Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 2005: 23(19):4406–4413. doi: 10.1200/JCO.2005.01.487 - DOI - PubMed
    1. Azoulay E, Mokart D, Pene F, Lambert J, Kouatchet A, Mayaux J et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium—a groupe de recherche respiratoire en reanimation onco-hematologique study. J Clin Oncol 2013: 31(22):2810–2818. doi: 10.1200/JCO.2012.47.2365 - DOI - PubMed
    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013: 39(2):165–228. doi: 10.1007/s00134-012-2769-8 - DOI - PMC - PubMed

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