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Vol. 45. Issue 6.
Pages 332-346 (August - September 2021)
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Vol. 45. Issue 6.
Pages 332-346 (August - September 2021)
Original
DOI: 10.1016/j.medine.2021.05.003
Epidemiology and prognosis of patients with a history of cancer admitted to intensive care. A multicenter observational study
Epidemiología y pronóstico de los pacientes con antecedentes de neoplasia ingresados en las Unidades de Cuidados Intensivos. Estudio multicéntrico observacional
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P.M. Olaechea Astigarragaa,
Corresponding author
polaechea54@gmail.com

Corresponding author.
, F. Álvarez Lermab, C. Beato Zambranoc, R. Gimeno Costad, F. Gordo Vidale,f, R. Durá Navarrog, C. Ruano Suarezh, T. Aldabó Pallási, J. Garnacho Monteroj, ENVIN-HELICS Study Group , List of supervisors and units participating in the ONCOENVIN study, ordered by number of patients contributed to the epidemiological study
a Servicio de Medicina Intensiva, Hospital Universitario Galdakao-Usansolo, Biocruces Bizkaia Health Research Institute, Galdácano, Vizcaya, Spain
b Servicio de Medicina Intensiva, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
c Servicio de Oncología Médica, Hospital Universitario Virgen Macarena, Sevilla, Spain
d Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
e Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain
f Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
g Servicio Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
h Servicio de Anestesiología y Reanimación, Hospital Universitario Cruces, Baracaldo, Vizcaya, Spain
i Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
j Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Tables (3)
Table 1. Comparison of patients with and without cancer admitted to the selected Units.
Table 2. Comparative analysis between patients with cancer according to background disease causing admission to the ICU. Coronary and trauma cases are excluded.
Table 3. Comparative analysis of patients with cancer according to reason for admission to the ICU.
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Additional material (1)
Abstract
Objective

To assess the epidemiology and outcome at discharge of cancer patients requiring admission to the Intensive Care Unit (ICU).

Design

A descriptive observational study was made of data from the ENVIN-HELICS registry, combined with specifically compiled variables. Comparisons were made between patients with and without neoplastic disease, and groups of cancer patients with a poorer outcome were identified.

Setting

Intensive Care Units participating in ENVIN-HELICS 2018, with voluntary participation in the oncological registry.

Patients

Subjects admitted during over 24 h and diagnosed with cancer in the last 5 years.

Primary endpoints

The general epidemiological endpoints of the ENVIN-HELICS registry and cancer-related variables.

Results

Of the 92 ICUs with full data, a total of 11,796 patients were selected, of which 1786 (15.1%) were cancer patients. The proportion of cancer patients per Unit proved highly variable (1%–48%). In-ICU mortality was higher among the cancer patients than in the non-oncological subjects (12.3% versus 8.9%; p < .001). Elective postoperative (46.7%) or emergency admission (15.3%) predominated in the cancer patients. Patients with medical disease were in more serious condition, with longer stay and greater mortality (27.5%). The patients admitted to the ICU due to nonsurgical disease related to cancer exhibited the highest mortality rate (31.4%).

Conclusions

Great variability was recorded in the percentage of cancer patients in the different ICUs. A total of 46.7% of the patients were admitted after undergoing scheduled surgery. The highest mortality rate corresponded to patients with medical disease (27.5%), and to those admitted due to cancer-related complications (31.4%).

Keywords:
Intensive care unit
Oncological patients
Epidemiology
Mortality rate
Resumen
Objetivo

Conocer la epidemiología y evolución al alta de los pacientes oncológicos que precisan ingreso en UCI.

Diseño

Estudio descriptivo observacional de datos del registro ENVIN-HELICS combinado con variables registradas específicamente. Se comparan pacientes con y sin neoplasia. Se identifican grupos de pacientes neoplásicos con peor evolución.

Ámbito

UCI participantes en ENVIN-HELICS del año 2018 con participación voluntaria en el registro oncológico.

Pacientes

Ingresados más de 24 horas. Entre estos aquellos diagnosticados de neoplasia en los últimos 5 años.

Variables principales

Las generales epidemiológicas del registro ENVIN-HELICS y variables relacionadas con la neoplasia.

Resultados

En las 92 UCI con datos completos se seleccionaron 11.796 pacientes, de los que 1.786 (15,1%) son pacientes con neoplasia. La proporción de pacientes con cáncer por unidad fue muy variable (rango: 1–48%). La mortalidad en UCI de los pacientes oncológicos fue superior a los no oncológicos (12,3% versus 8,9%; p < 0,001). En pacientes oncológicos predominaron los ingresados en el postoperatorio programado (46,7%) o urgente (15,3%). Los pacientes con proceso patológico médico fueron más graves, con mayor estancia y mortalidad (27,5%). Aquellos ingresados en UCI por enfermedad no quirúrgica relacionada con el cáncer tuvieron la mortalidad más alta (31,4%).

Conclusión

Existe una gran variabilidad en el porcentaje de pacientes oncológicos en las diferentes UCI. El 46,7% de los pacientes ingresa tras someterse a cirugía programada. La mayor mortalidad corresponde a pacientes con enfermedad médica (27,5%) y a los ingresados por complicaciones relacionadas con el cáncer (31,4%).

Palabras clave:
Unidad de cuidados intensivos
Paciente oncológico
Epidemiología
Mortalidad

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