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Meta-Analysis
. 2021 Feb:61:82-88.
doi: 10.1016/j.jcrc.2020.10.008. Epub 2020 Oct 15.

Impact of early ICU admission on outcome of critically ill and critically ill cancer patients: A systematic review and meta-analysis

Yannick Hourmant  1 , Arnaud Mailloux  1 , Sandrine Valade  1 , Virginie Lemiale  1 , Elie Azoulay  2 , Michael Darmon  3
Affiliations
Meta-Analysis

Impact of early ICU admission on outcome of critically ill and critically ill cancer patients: A systematic review and meta-analysis

Yannick Hourmant et al. J Crit Care. 2021 Feb.

Abstract

Objective: Prognostic impact of early ICU admission remains controversial. The aim of this review was to investigate the impact of early ICU admission in the general ICU population and in critically ill cancer patients and to report level of evidences of this later.

Methods: Systematic review and meta-analysis performed on articles published between 1970 and 2017. Two authors extracted data. Influence of early ICU admission on mortality is reported as Risk Ratio (95%CI) using both fixed and random-effects model.

Data synthesis: For general ICU population, 31 studies reporting on 73,213 patients were included (including 66,797 patients with early ICU admission) and for critically ill cancer patients 14 studies reporting on 2414 patients (including 1272 with early ICU admission) were included. Early ICU admission was associated with decreased mortality using a random effect model (RR 0.65; 95% confidence interval 0.58-0.73; I2 = 66%) in overall ICU population as in critically ill cancer patients (RR 0.69; 95% confidence interval 0.52-0.90; I2 = 85%). To explore heterogeneity, a meta-regression was performed. Characteristics of the trials (prospective vs. retrospective, monocenter vs. multicenter) had no impact on findings. Publication after 2010 (median publication period) was associated with a lower effect of early ICU admission (estimate 0.37; 95%CI 0.14-0.60; P = 0.002) in the general ICU population. A significant publication bias was observed.

Conclusion: Theses results suggest that early ICU admission is associated with decreased mortality in the general ICU population and in CICP. These results were however obtained from high risk of bias studies and a high heterogeneity was noted. Systematic review registration: PROSPERO 2018 CRD42018094828.

Keywords: Admission; Cancer; Delay; Intensive care unit; Mortality; Outcome.

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Conflict of interest statement

Declaration of Competing Interest M. Darmon has received fees from Sanofi MSD, Gilead-Kite and Astellas, and research support from MSD. E. Azoulay has received fees for lectures from Gilead, Pfizer, Baxter and Alexion. His research group has been supported by Ablynx, Ficher & Payckle, Jazz Pharma, and MSD. S.Valade has received fees from Sanofi (teaching) and Pfizer (invitation to congress). The other authors declare having no conflict of interest related to this manuscript.