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

Fernando G. Zampieri, Thiago G. Romano, Jorge I.F. Salluh, Leandro U. Taniguchi, Pedro V. Mendes, Antonio P. Nassar, Roberto Costa, William N. Viana, Marcelo O. Maia, Mariza F.A. Lima, Sylas B. Cappi, Alexandre G.R. Carvalho, Fernando V.C. De Marco, Marcelo S. Santino, Eric Perecmanis, Fabio G. Miranda, Grazielle V. Ramos, Aline R. Silva, Paulo M. Hoff, Fernando A. BozzaMarcio Soares*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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.

Original languageEnglish
JournalIntensive Care Medicine
Volume47
Issue number2
Pages (from-to)170-179
ISSN0342-4642
DOIs
Publication statusPublished - Feb 2021

Keywords

  • Bayesian analysis
  • Cancer
  • Critical care
  • Mortality trends
  • Multicenter study

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