Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study

Fernando G Zampieri^{1

2

3}, Thiago G Romano^{4

5

6}, Jorge I F Salluh⁷, Leandro U Taniguchi^{8

9}, Pedro V Mendes^{4

9

6}, Antonio P Nassar Jr¹⁰, Roberto Costa¹¹, William N Viana¹², Marcelo O Maia^{13

14}, Mariza F A Lima¹⁵, Sylas B Cappi¹⁶, Alexandre G R Carvalho¹⁷, Fernando V C De Marco¹⁸, Marcelo S Santino¹⁹, Eric Perecmanis²⁰, Fabio G Miranda²¹, Grazielle V Ramos⁷, Aline R Silva⁷, Paulo M Hoff^{1

22}, Fernando A Bozza^{7

23}, Marcio Soares²⁴

Affiliations

¹ Department of Critical Care, D'Or Institute for Research and Education, 30. Botafogo, Rio de Janeiro, Brazil.
² Research Institute, HCor, São Paulo, Brazil.
³ Center of Epidemiological and Clinical Research, Southern Denmark University, Odense, Denmark.
⁴ Intensive Care Unit, Hospital Vila Nova Star, São Paulo, Brazil.
⁵ Nephrology Department, ABC Medical School, Santo André, Brazil.
⁶ Oncological Intensive Care Unit, Unidade Itaim, Hospital São Luiz, São Paulo, Brazil.
⁷ Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
⁸ Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
⁹ Emergency Medicine Discipline, University of São Paulo, São Paulo, Brazil.
¹⁰ Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil.
¹¹ Intensive Care Unit, Hospital Quinta D'Or, Rio de Janeiro, Brazil.
¹² Intensive Care Unit, Hospital Copa D'Or, Rio de Janeiro, Brazil.
¹³ Intensive Care Unit, Hospital Santa Luzia Rede D'Or São Luiz, Brasília, Brazil.
¹⁴ Intensive Care Unit, Hospital DF Star Rede D'Or São Luiz, Brasília, Brazil.
¹⁵ Intensive Care Unit, Hospital Esperança Recife, Recife, Brazil.
¹⁶ Intensive Care Unit, Unidade Brasil, Hospital São Luiz, Santo André, Brazil.
¹⁷ Intensive Care Unit, UDI Hospital, São Luís, Brazil.
¹⁸ Intensive Care Unit, Hospital ViValle, São José dos Campos, Brazil.
¹⁹ Intensive Care Unit, Hospital Barra D'Or, Rio de Janeiro, Brazil.
²⁰ Intensive Care Unit, Hospital Caxias D'Or, Duque de Caxias, Brazil.
²¹ Intensive Care Unit, Hospital Copa Star, Rio de Janeiro, Brazil.
²² Oncologia D'Or, São Paulo, Brazil.
²³ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
²⁴ Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil. marciosoaresms@gmail.com.

PMID: 32770267
DOI: 10.1007/s00134-020-06184-2

Multicenter Study

Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study

Fernando G Zampieri et al. Intensive Care Med. 2021 Feb.

. 2021 Feb;47(2):170-179.

doi: 10.1007/s00134-020-06184-2. Epub 2020 Aug 7.

Authors

Affiliations

¹ Department of Critical Care, D'Or Institute for Research and Education, 30. Botafogo, Rio de Janeiro, Brazil.
² Research Institute, HCor, São Paulo, Brazil.
³ Center of Epidemiological and Clinical Research, Southern Denmark University, Odense, Denmark.
⁴ Intensive Care Unit, Hospital Vila Nova Star, São Paulo, Brazil.
⁵ Nephrology Department, ABC Medical School, Santo André, Brazil.
⁶ Oncological Intensive Care Unit, Unidade Itaim, Hospital São Luiz, São Paulo, Brazil.
⁷ Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
⁸ Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
⁹ Emergency Medicine Discipline, University of São Paulo, São Paulo, Brazil.
¹⁰ Intensive Care Unit, A.C. Camargo Cancer Center, São Paulo, Brazil.
¹¹ Intensive Care Unit, Hospital Quinta D'Or, Rio de Janeiro, Brazil.
¹² Intensive Care Unit, Hospital Copa D'Or, Rio de Janeiro, Brazil.
¹³ Intensive Care Unit, Hospital Santa Luzia Rede D'Or São Luiz, Brasília, Brazil.
¹⁴ Intensive Care Unit, Hospital DF Star Rede D'Or São Luiz, Brasília, Brazil.
¹⁵ Intensive Care Unit, Hospital Esperança Recife, Recife, Brazil.
¹⁶ Intensive Care Unit, Unidade Brasil, Hospital São Luiz, Santo André, Brazil.
¹⁷ Intensive Care Unit, UDI Hospital, São Luís, Brazil.
¹⁸ Intensive Care Unit, Hospital ViValle, São José dos Campos, Brazil.
¹⁹ Intensive Care Unit, Hospital Barra D'Or, Rio de Janeiro, Brazil.
²⁰ Intensive Care Unit, Hospital Caxias D'Or, Duque de Caxias, Brazil.
²¹ Intensive Care Unit, Hospital Copa Star, Rio de Janeiro, Brazil.
²² Oncologia D'Or, São Paulo, Brazil.
²³ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
²⁴ Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil. marciosoaresms@gmail.com.

PMID: 32770267
DOI: 10.1007/s00134-020-06184-2

Erratum in

Correction to: Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study.
Zampieri FG, Romano TG, Salluh JIF, Taniguchi LU, Mendes PV, Nassar AP Jr, Costa R, Viana WN, Maia MO, Lima MFA, Cappi SB, Carvalho AGR, De Marco FVC, Santino MS, Perecmanis E, Miranda FG, Ramos GV, Silva AR, Hoff PM, Bozza FA, Soares M. Zampieri FG, et al. Intensive Care Med. 2021 Feb;47(2):259-260. doi: 10.1007/s00134-020-06252-7. Intensive Care Med. 2021. PMID: 33006683 No abstract available.

Abstract

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.

Keywords: Bayesian analysis; Cancer; Critical care; Mortality trends; Multicenter study.

PubMed Disclaimer

References

1. Azoulay E, Schellongowski P, Darmon M et al (2017) The intensive care medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med 43:1366–1382. https://doi.org/10.1007/s00134-017-4884-z - DOI - PubMed
1. Puxty K, McLoone P, Quasim T et al (2015) Risk of critical illness among patients with solid cancers: a population-based observational study. JAMA Oncol 1:1078–1085. https://doi.org/10.1001/jamaoncol.2015.2855 - DOI
1. Soares M, Bozza FA, Azevedo LCP et al (2016) Effects of organizational characteristics on outcomes and resource use in patients with cancer admitted to intensive care units. J Clin Oncol Off J Am Soc Clin Oncol 34:3315–3324. https://doi.org/10.1200/JCO.2016.66.9549 - DOI
1. Shimabukuro-Vornhagen A, Böll B, Kochanek M et al (2016) Critical care of patients with cancer. CA Cancer J Clin 66:496–517. https://doi.org/10.3322/caac.21351 - DOI - PubMed
1. Gutierrez C, McEvoy C, Munshi L et al (2020) Critical care management of toxicities associated with targeted agents and immunotherapies for cancer. Crit Care Med 48:10–21. https://doi.org/10.1097/CCM.0000000000004087 - DOI - PubMed - PMC

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

302188/2018-5/Conselho Nacional de Desenvolvimento Científico e Tecnológico

LinkOut - more resources

Full Text Sources
- Springer
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study

Affiliations

Trends in clinical profiles, organ support use and outcomes of patients with cancer requiring unplanned ICU admission: a multicenter cohort study

Authors

Affiliations

Erratum in

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous