Severity of illness scores may misclassify critically ill obese patients

Autores: R. O. Deliberato1,2, S. Ko2,3, L.A. Celi2,4, D.J. Stone2,51 Hospital Israelita Albert Einstein, Critical Care, São Paulo, Brazil;2 Massachusetts Institute of Technology, Harvard-MIT Health Sciences and Technology, Cambridge, United States; 3 Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, United States; 4 Beth Israel Deaconess Medical Center, Department of Medicine, Boston, United States; 5 University of Virginia School of Medicine, Anesthesiology and Neurosurgery, Charlottesville, United States Correspondence: R. O. Deliberato Intensive Care Medicine Experimental 2017, 5(Suppl 2):0206

Introdução: There is an increase demand for intensive care unit (ICU) admission of elderly oncological patients, but the outcome and factors related to hospital mortality in this subgroup of critically ill patients are still understudied. Our objective was to assess risk factors for hospital death in a cohort of elderly patients with solid cancer admitted to the ICU.

Métodos: This is a retrospective cohort study conducted at a private tertiary oncological hospital (Hospital Sírio-Libanês) at São Paulo, Brazil. We extracted relevant information from the adult ICU database (sistema Epimed™). All consecutive patients ≥ 65 years old with a diagnosis of active solid cancer were evaluated. We used univariate and multivariate analysis to identify risk factors associated with hospital mortality.

Resultados: Between July 2012 to June 2016 we studied 1562 patients ≥ 65 years old who had cancer (hospital mortality of 17.1%). Patients who died were more severely ill compared to patients those who survived (SAPS 3 of 59 [52–68] versus 42 [36–53] respectively; p < 0.001), were older, more frequently came from the ward with
longer hospital length of stay before ICU admission, had more comorbidities and worse performance status, higher prevalence of metastatic disease, more frequently required mechanical ventilation and vasoactive drugs as well as dialysis, and had a different pattern of primary tumor site. Independent risk factors for hospital mortality
in our multivariate logistic model were higher SOFA score, admission source other than the operating room, longer length of stay before ICU transfer, invasive life support procedures, metastatic disease, primary tumor site and worse physiological parameters at ICU admission.

Conclusão: Most of risk factor for hospital death in our cohort were similar to non-oncological patients and reflect the severity of critical illness.