Medicina Intensiva  (English Edition) Medicina Intensiva  (English Edition)
Original
Oncological patients admitted to an intensive care unit. Analysis of predictors of in-hospital mortality
Pacientes oncológicos ingresados en Unidad de Cuidados Intensivos. Análisis de factores predictivos de mortalidad
D. Díaz-Díaz, , M. Villanova Martínez, E. Palencia Herrejón
Servicio de Medicina Intensiva, Hospital Universitario Infanta Leonor, Madrid, Spain
Received 18 September 2017, Accepted 11 February 2018
Abstract
Objective

To analyze the factors influencing in-hospital mortality among cancer patients admitted to an Intensive Care Unit (ICU).

Design

A retrospective observational study was carried out.

Setting

The ICU of a community hospital.

Patients

Adults diagnosed with solid or hematological malignancies admitted to the ICU, excluding those admitted after scheduled surgery and those with an ICU stay of under 24h.

Interventions

Review of clinical data.

Variables of interest

Referring ward and length of stay prior to admission to the ICU, type of tumor, extent, Eastern Cooperative Oncology Group (ECOG) score, reason for ICU admission, severity (SOFA, APACHE-II, SAPS-II), type of therapy received in the ICU, and in-hospital mortality.

Results

A total of 167 patients (mean age 71.1 years, 62.9% males; 79% solid tumors) were included, of which 61 (36%) died during their hospital stay (35 in the ICU). The factors associated to increased in-hospital mortality were ECOG scores 3–4 (OR 7.23, 95%CI: 1.95–26.87), metastatic disease (OR 3.77, 95%CI: 1.70–8.36), acute kidney injury (OR 3.66, 95%CI: 1.49–8.95) and SOFA score at ICU admission (OR 1.26, 95%CI: 1.10–1.43). A total of 60.3% of the survivors were independent at hospital discharge.

Conclusions

In our series, only one-third of the critically ill cancer patients admitted to the ICU died during hospital admission, and more than 50% showed good performance status at hospital discharge. The clinical prognostic factors associated to in-hospital mortality were poor performance status, metastatic disease, SOFA score at ICU admission and acute kidney injury.

Resumen
Objetivo

Analizar qué factores clínicos influyen en la mortalidad de pacientes con cáncer que ingresan en UCI.

Diseño

Estudio observacional retrospectivo.

Ámbito

UCI de un hospital secundario.

Pacientes

Adultos ingresados en UCI con diagnóstico de cáncer (sólido o hematológico), excluyendo a aquellos ingresados en el postoperatorio de resección programada del tumor o con estancia inferior a 24 h en UCI.

Intervenciones

Revisión de datos clínicos.

Variables de interés

Tipo de tumor, extensión, escala oncológica funcional Eastern Cooperative Oncology Group (ECOG), motivo de ingreso en UCI, gravedad (SOFA, APACHE-II, SAPS-II), terapia recibida y mortalidad hospitalaria.

Resultados

Se incluyó a 167 pacientes (edad media 71,1 años; 62,9% varones; el 79% con tumor sólido), de los cuales fallecieron 61 (36%) durante su estancia hospitalaria (35 en UCI). Los factores clínicos asociados a mayor riesgo de muerte hospitalaria fueron la puntuación 3-4 en la escala ECOG (OR 7,23; IC 95%: 1,95-26,87), extensión metastásica del tumor (OR 3,77; IC 95%: 1,70-8,36), insuficiencia renal (OR 3,66; IC 95%: 1,49-8,95) y puntuación SOFA al ingreso (OR 1,26; IC 95%: 1,10-1,43). El 60,3% de los supervivientes eran independientes al alta hospitalaria.

Conclusiones

En nuestra serie, solo un tercio de los pacientes con enfermedad oncológica grave que requieren ingreso en UCI fallecen durante el ingreso hospitalario y más de la mitad de los supervivientes presentan una situación de independencia al alta hospitalaria. Los factores clínicos asociados a la mortalidad hospitalaria fueron la mala situación funcional previa, el antecedente de tumor metastásico, la puntuación SOFA al ingreso en UCI y la presencia de insuficiencia renal aguda.

Keywords
Intensive Care Unit, Cancer, In-hospital mortality, Outcome, Performance status
Palabras clave
Unidad de Cuidados Intensivos, Cáncer, Mortalidad hospitalaria, Pronóstico, Situación funcional
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