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VOLUME 25 , ISSUE 12 ( December, 2021 ) > List of Articles

Original Article

Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study

Amit M Narkhede, Harish K Chaudhari, Ujwal Dhundi, Satish Sarode, Jigeeshu Divatia

Citation Information : Narkhede AM, Chaudhari HK, Dhundi U, Sarode S, Divatia J. Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study. Indian J Crit Care Med 2021; 25 (12):1421-1426.

DOI: 10.5005/jp-journals-10071-24052

License: CC BY-NC 4.0

Published Online: 17-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Objectives: Critically ill solid organ malignancy patients admitted to intensive care unit (ICU) as unplanned medical admissions behave differently from other subsets of cancer patients (hematolymphoid malignancies and cancer patients admitted for postoperative care). These patients if appropriately selected may benefit from the ICU care. There is paucity of data on critically ill unplanned admissions of solid organ malignancies from South Asia. We analyzed data of patients with solid tumors with unplanned admissions to the ICU to determine the clinical, epidemiological characteristics, and predictors of hospital mortality in an Indian ICU. Materials and methods: This prospective, observational study was done in our 14-bedded mixed medical–surgical ICU from July 2014 to November 2015. We included all consecutive adult unplanned admissions with solid organ malignancies having ICU stay of >24 hours. Surgical admissions, hematolymphoid malignancies, advanced malignancy with no treatment options, and those cured of cancer >5 years were excluded. Results: Two hundred and thirty-five consecutive patients were included in this cohort. ICU and hospital mortalities were 36.6 and 40%, respectively. On multivariate analysis, cancer status [odds ratio (OR): 3.204; 95% confidence interval (CI): 1.271–8.078], invasive mechanical ventilation (OR: 5.940; 95% CI: 2.632–13.408), and sequential organ failure assessment (SOFA) score on the day of ICU admission (OR: 1.199; 95% CI: 1.042–1.379) were independent predictors of hospital mortality. Conclusion: Acute respiratory failure and septic shock are the common reasons of unplanned ICU admission for patients with solid organ malignancies. With good patient selection, more than half of such patients are likely to be discharged alive from the hospital.


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  1. Ostermann M, Ferrando-Vivas P, Gore C, Power S, Harrison D. Characteristics and outcome of cancer patients admitted to the ICU in England, Wales, and Northern Ireland and national trends between 1997 and 2013. Crit Care Med 2017;45(10):1668–1676. DOI: 10.1097/CCM.0000000000002589.
  2. Darmon M, Bourmaud A, Georges Q, Soares M, Jeon K, Oeyen S, et al. Changes in critically ill cancer patients’ short-term outcome over the last decades: results of systematic review with meta-analysis on individual data. Intensive Care Med 2019;45(7):977–987. DOI: 10.1007/s00134-019-05653-7.
  3. Carlon GC. Just say no. Crit Care Med 1989;17(1):106–107. PMID: 2909310.
  4. Auclin E, Charles-Nelson A, Abbar B, Guérot E, Oudard S, Hauw-Berlemont C, et al. Outcomes in elderly patients admitted to the intensive care unit with solid tumors. Ann Intensive Care 2017;7(1):26. DOI: 10.1186/s13613-017-0250-0.
  5. Soares M, Bozza FA, Azevedo LC, Silva UV, Corrêa TD, Colombari F, et al. Effects of organizational characteristics on outcomes and resource use in patients with cancer admitted to intensive care units. J Clin Oncol 2016;34(27):3315–3324. DOI: 10.1200/JCO.2016.66.9549.
  6. Azoulay E, Mokart D, Pène 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 réanimation onco-hématologique study. J Clin Oncol 2013;31(22):2810–2818. DOI: 10.1200/JCO.2012.47.2365.
  7. Vincent F, Ayed S, Bouguerba A, Yaacoubi S, Bornstain C. Prognosis of cancer patients in the ICU: much work remains. Respir Care 2017;62(9):1230–1232. DOI: 10.4187/respcare.
  8. Bos MM, de Keizer NF, Meynaar IA, Bakhshi-Raiez F, de Jonge E. Outcomes of cancer patients after unplanned admission to general intensive care units. Acta Oncol 2012;51(7):897–905. DOI: 10.3109/0284186X.2012.679311.
  9. Na SJ, Ha TS, Koh Y, Suh GY, Koh SO, Lim CM, et al. Characteristics and clinical outcomes of critically ill cancer patients admitted to Korean intensive care units. Acute Crit Care 2018;33(3):121–129. DOI: 10.4266/acc.2018.00143.
  10. Tan AC, Jacques SK, Oatley M, Guminski AD. Characteristics and outcomes of oncology unit patients requiring admission to an Australian intensive care unit. Intern Med J 2019;49(6):734–739. DOI: 10.1111/imj.14160.
  11. Fisher R, Dangoisse C, Crichton S, Whiteley C, Camporota L, Beale R, et al. Short-term and medium-term survival of critically ill patients with solid tumours admitted to the intensive care unit: a retrospective analysis. BMJ Open 2016;6(10):e011363. DOI: 10.1136/bmjopen-2016-011363.
  12. Xia R, Wang D. Intensive care unit prognostic factors in critically ill patients with advanced solid tumors: a 3-year retrospective study. BMC Cancer 2016;16:188. DOI: 10.1186/s12885-016-2242-0.
  13. Puxty K, McLoone P, Quasim T, Kinsella J, Morrison D. Survival in solid cancer patients following intensive care unit admission. Intensive Care Med 2014;40(10):1409–1428. DOI: 10.1007/s00134-014-3471-9.
  14. Namendys-Silva SA, Texcocano-Becerra J, Herrera-Gómez A. Prognostic factors in critically ill patients with solid tumours admitted to an oncological intensive care unit. Anaesth Intensive Care 2010;38(2):317–324. DOI: 10.1177/0310057X1003800214.
  15. Kingah P, Alzubaidi N, Yafawi JZD, Shehada E, Alshabani K, Soubani AO. Factors associated with mortality in patients with a solid malignancy admitted to the intensive care unit – a prospective observational study. J Crit Care Med (Targu Mures) 2018;4(4):137–142. DOI: 10.2478/jccm-2018-0019.
  16. Soares M, Caruso P, Silva E, Teles JM, Lobo SM, Friedman G, et al. Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med 2010;38(1):9–15. DOI: 10.1097/CCM.0b013e3181c0349e.
  17. Vincent F, Soares M, Mokart D, Lemiale V, Bruneel F, Boubaya M, et al. In-hospital and day-120 survival of critically ill solid cancer patients after discharge of the intensive care units: results of a retrospective multicenter study – A Groupe de recherche respiratoire en réanimation en Onco-Hématologie (Grrr-OH) study. Ann Intensive Care 2018;8(1):40. DOI: 10.1186/s13613-018-0386-6.
  18. Díaz-Díaz D, Villanova Martínez M, Palencia Herrejón E. Oncological patients admitted to an intensive care unit. Analysis of predictors of in-hospital mortality. Med Intensiva 2018;42(6):346–353. DOI: 10.1016/j.medin.2018.02.001.
  19. Epstein AS, Yang A, Colbert LE, Voigt LP, Meadows J, Goldberg JI, et al. Outcomes of ICU admission of patients with progressive metastatic gastrointestinal cancer. J Intensive Care Med 2020;35(3):297–302. DOI: 10.1177/0885066617748874.
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