ICU mortality among oncological patients at a public cancer hospital in São Luís-Northeast Brazil: three-year evaluation
Autores: AP. Pierre de Moraes, G. Alves , JR. Lima, AA. Silva, Y. Assis Intensive Care Unit, Cancer Hospital of Maranhao Tarquinio Lopes Filho, São Luís, Brazil; Public health, Federal University of Maranhão, São Luís – Vila Maranhão, São Luís – State of Maranhão, Brazil, Brazil
Correspondência: A.P. Pierre de Moraes
Intensive Care Medicine Experimental 2019, 7(Suppl 3):000556
Recent studies point out that the severity of acute complications, the number of organ disfunction, the management complexity and performance status have more impact on ICU mortality among cancer patients than the underlying neoplasm disease [1-3].
To evaluate risk factors for ICU mortality among cancer patients.
A retrospective study conducted at a 11-bed ICU of a public cancer hospital in São Luis, one of the capitals of northeastern Brazil. We evaluated all cancer patients > 18 years old requiring ICU admission from January 2016 to December 2018, excluding those in palliative care support, readmission, and those that had ICU stay <24 hours. We evaluated demographic and clinical variables, ICU support at admission and during ICU stay by univariate and multivariate analysis. The risk factors for ICU mortality were investigated through
multiple logistic regression analysis.
Out of 1021 patients, 699 (68%) had solid locoregional tumors, 182 (18%) had solid metastatical tumors and 140 (14%) were onco-hematology patients. The main solid tumor sites were gastrointestinal 254 (25%), gynecological 152 (15%), and urological 107 (11%). There were 438 (43%) admissions due to medical reasons, 553 (52%) and 50 (5%) for postoperative care after elective and emergency surgery, respectively. The overall ICU mortality was 34%. At multivariate analysis, the independent risk factors for ICU mortality
were: admission due to medical reasons (OR = 7,57; 95%CI: 4,39-13,08) or due to emergency surgery (OR=2,78; 95%CI 1,27-6,08), high SAPS 3 (OR = 1,03; 95%CI: 1,01-1,04) and high SOFA scores at admission (OR = 1,17; 95%CI: 1,08-1,26), need of mechanical ventilation (OR = 2,94; 95%CI: 1,94-4,46), use of vasoactive drugs during ICU stay (OR = 2,19; 95%CI: 1,36-3,55) and nosocomial ICU infection (OR = 3,96; 95%CI: 2,26-6,93).
An unplanned ICU admission, higher severity scores upon ICU admission, complex support and infection during ICU stay were identified as risk factors for ICU mortality. The severity of acute illness at ICU admission may suggest that prompt recognition of organ dysfunction and the possibility of early ICU referral could offer opportunities to better management of acute critical complications. The expansion of prevention strategies to reduce hospital-acquired infection would be important for improving ICU mortality rates.
1. Soares M, Caruso P, Silva E, 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
2. Biskup E, Cai F, Vetter M, Marsch S. Oncological patients in the intensive care unit: prognosis, decision-making, therapies and end-of-life care. Swiss Med Wkly. 2017;147: w14481
3. Azoulay E, Schellongowski P, Darmon M, Bauer PR, Benoit D, Depuydt P, et al. The Intensive Care Medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med 2017;43(9):1366-1382.000559