Risk factors and outcomes of severe acute respiratory failure requiring invasive mechanical ventilation in cancer patients: A retrospective cohort study

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SARF-MV: severe acute respiratory failure requiring invasive mechanical ventilation." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F.D. Martos-Benítez, A. Gutiérrez-Noyola, M. Badal, N.A. Dietrich" "autores" => array:4 [ 0 => array:2 [ "nombre" => "F.D." "apellidos" => "Martos-Benítez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Gutiérrez-Noyola" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Badal" ] 3 => array:2 [ "nombre" => "N.A." 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Martos-Benítez, A. Gutiérrez-Noyola, M. Badal, N.A. Dietrich" "autores" => array:4 [ 0 => array:4 [ "nombre" => "F.D." "apellidos" => "Martos-Benítez" "email" => array:1 [ 0 => "fdmartos@infomed.sld.cu" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Gutiérrez-Noyola" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Badal" ] 3 => array:2 [ "nombre" => "N.A." "apellidos" => "Dietrich" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Intensive Care, Institute of Oncology and Radiobiology, 29 Street, Vedado, Havana, Cuba" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores de riesgo y resultados de la insuficiencia respiratoria grave que requiere ventilación mecánica invasiva en pacientes oncológicos: un estudio de cohortes retrospectivo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 952 "Ancho" => 1688 "Tamanyo" => 86291 ] ] "descripcion" => array:1 [ "en" => "Causes of severe acute respiratory failure requiring invasive mechanical ventilation." ] ] ] "textoCompleto" => "IntroductionAcute respiratory failure (ARF) is a frequent disorder in cancer patients, commonly caused by several conditions including local effect of tumour, pulmonary infiltrates, pneumonia, acute respiratory distress syndrome and congestive heart failure. Supplemental oxygen and treatment of the underlying disorder is the mainstay of treatment for ARF, but severe cases require ventilatory support. Indeed, the need of this treatment modality is one of most frequent reasons for admission in the intensive care unit (ICU) for critically ill cancer patients.<a class="elsevierStyleCrossRefs" href="#bib0185">1–3</a>Mechanical ventilation (MV) is a primary method of organic function support in critically ill cancer patients treated in ICU, usually indicating a severe ARF (SARF). However, despite significant advances in ventilatory support and cancer management, MV remains associated with a high ICU, hospital and long-term mortality rate.<a class="elsevierStyleCrossRefs" href="#bib0200">4,5</a> In addition, the need of MV because of postoperative respiratory failure in operated cancer patients has been reported as high as 37%,<a class="elsevierStyleCrossRef" href="#bib0210">6</a> which is associated with unfavourable outcomes as well.<a class="elsevierStyleCrossRefs" href="#bib0210">6,7</a>Although some previous studies have reported an association between SARF and VM with mortality in critically ill cancer patients, this relation is not clear because of methodological designs, participants’ characteristics and limitations of the studies. Conversely, the risk factors for SARF have not been consistently investigated in this type of patients. The study was aimed: 1) to identify the risk factors for severe acute respiratory failure requiring invasive mechanical ventilation (SARF-MV); and 2) to determine the effects of SARF-MV on clinical outcomes in cancer patients admitted in an oncological ICU.Patients and methodsDesign and settingThis was a retrospective cohort study conducted in the oncological ICU of the Institute of Oncology and Radiobiology (IOR). This is a 220-bed, university-affiliated, tertiary care referral centre for cancer patients in Havana, Cuba. The ICU has 12 beds and provides care for about 500 medical and surgical cancer patients per year. Data source was the prospective database of the ICU and hospital records (January 2014–December 2015). The study was approved by the Scientific Council and the Ethics Committee for Scientific Research of the IOR. Informed consent was waivered because of the retrospective nature of the study. It was conducted in accordance with the Declaration of Helsinki.ParticipantsOver the study period, a total of 878 consecutive cancer patients were included. Patients with a length of ICU stay ≤1 day were excluded (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>For those patients who were admitted more than once to the ICU during the same hospitalization, only the first data on ICU admission were analyzed. To be admitted, the oncologist and the ICU physician generally were agreed that patients had a potential chance of recovering from the acute problem. In contrast, patients without any further oncology specific treatment options were offered end-of-life care on the referring ward and not transferred to the ICU.Data collection and outcomesThe following variables on ICU admission were extracted from the medical records: age, sex, Age-Adjusted Charlson Comorbidity Index score with the exclusion of malignancy,<a class="elsevierStyleCrossRef" href="#bib0220">8</a> primary tumour location, clinical stage of cancer,<a class="elsevierStyleCrossRef" href="#bib0225">9</a> patient origin (hospital ward or emergency department), malignancy-unrelated admission, type of admission (medical or surgical), emergency surgery, Acute Physiology and Chronic Health Evaluation (APACHE) II score, transfusion of blood products within 15 days prior to ICU admission, sepsis according to the Surviving Sepsis Campaign,<a class="elsevierStyleCrossRef" href="#bib0230">10</a> and adverse event to chemotherapy as cause for admission in ICU.The outcome of interest was the SARF-MV, defined as the need of invasive mechanical ventilation because of the presence of respiratory distress symptoms such as tachypnea (respiratory rate>30min–1), an arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio<300mmHg or hypercapnia with abnormal mental status. We also assessed the effect of SARF-MV on clinical outcomes such as length of ICU and hospital stay, as well as ICU and hospital mortality.Statistical analysisCategorical variables are showed as count with percentage and numerical variables as median with 25th to 75th interquartile range (IQR). Difference between groups was performed using Pearson's chi-square test (χ2) or Fisher's exact test as appropriated for categorical variables; because of lack of normality, the Mann–Whitney U test was used for numerical variables.Multivariate logistic regression model was used to identify risk factors associated with SARF-MV. Explanatory variables yielding p-values≤0.05 by univariate analysis and those clinically relevant were considered to enter in the initial model. Parsimony of the model was guaranteed. Because of lack of normality, numerical variables were stratified according to the analysis of the functional form and clinical significance. Development of model was based on backward stepwise (likelihood ratio) significance testing (p-value to enter: 0.10; p-value to remove: 0.15). The Hosmer–Lemeshow test was used to check the goodness of fit. Discrimination capability was evaluated by determination of the area under the receiver operating characteristic (ROC) curve. Results were summarized as odds ratio (OR) and respective 95% confidence interval (CI).The survival was estimated by the Kaplan–Meier method. The follow-up time was marked by the date of ICU admission and by the date of hospital discharge. The survival rate was compared using the log-rank test.Statistical test with a two tailed p-value≤0.05 was considered as significant. Data were analyzed using IBM® SPSS® Statistics 21.0 (IBM, Chicago, IL, USA).ResultsCharacteristics of study populationA total of 691 patients were analyzed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The main characteristics of study population are depicted in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Patients with history of chronic disease were 468 (67.7%). The median in the Age-Adjusted Charlson Comorbidity Index score was 3.0 points (IQR 2.0–5.0 points); a score≥2 points was observed in 86.4% of subjects.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Postoperative care was the most common cause for admission in ICU (78.6%). Gastrointestinal tract (46.6%) and thorax (27.4%) were the most frequent sites for surgical interventions. The emergency surgery was carried out in 5.5% of the operated patients. The most common causes for admission in ICU in medical patients were acute respiratory failure (32.4%), infections (30.4%), cardiovascular disorders (19.6%), neurological disorders (9.5%), and others (8.1%).Probability of death estimated by APACHE II was 11.7% (IQR 8.5–18.5%). Eighty-one patients (11.7%) required vasopressors during their stay in ICU. Thirty-four patients (4.9%) were re-admitted to ICU during the same hospitalization.Risk factors for SARF-MVA total of 109 patients (15.8%) developed SARF-MV. The SARF-MV rate was 31.1% for medical patients and 11.6% for surgical patients. ARF secondary to non-pulmonary sepsis (31.2%) such as peritonitis (25 cases), urinary tract infection (two cases), soft tissue infection (six cases) and central nervous system infection (one case), as well as pneumonia (22.9%) were the main causes of SARF-MV. Other causes were postoperative respiratory failure (18.3%) because of difficult weaning (seven cases), circulatory instability (six), atelectasis (two cases) or volume overload (five cases); non-septic neurological disorders (11.0%) such as brain metastasis (four cases), ischaemic stroke (five cases) or brain haemorrhage (three cases); cardiovascular disorders (10.1%) such as acute pulmonary embolism (four cases), acute myocardial infarction (three cases), acute pulmonary oedema (two cases) or haemorrhage (two cases); and non-septic pulmonary disorders (6.4%) such as aspiration (two cases) or acute respiratory distress syndrome because of pancreatitis (one case) and drugs reaction (four cases) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>In the univariate analysis, primary tumour location, clinical stage of cancer, admission from the emergency department, medical admission, malignancy-unrelated admission, sepsis, adverse event to chemotherapy, and APACHE II score were related with SARF-MV (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).In multivariate logistic regression analysis, brain tumour, stage IV-cancer, sepsis at ICU admission, and APACHE II score≥20 points were independently associated with increased risk of SARF-MV (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Outcomes of patients with SARF-MVThe overall ICU and hospital mortality rate was 10.9% and 14.0%, respectively. Median length of ICU and hospital stay was 3.0 days (IQR 2.0–4.0 days) and 9.0 days (IQR 6.0–13.0 days), respectively. Compared with patients without respiratory failure, those with SARF-MV had a prolonged length of ICU stay (Mann–Whitney U test, p<0.0001), an increased ICU mortality rate (χ2=155.53; p<0.0001), and an increased hospital mortality rate (χ2=172.37; p<0.0001) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The median ICU and hospital survival time of the total cohort was 14.0 days (95% CI 11.4–16.6 days) and 39.0 days (95% CI 34.6–43.4 days), respectively. Of the 109 patients with SARF-MV, 49 died in ICU. Of the 49 patients, 27 died from septic shock, 10 from respiratory failure, six from neurological disorders, five from cardiogenic shock, and one from hypovolemic shock due to haemorrhage. Therefore, the ICU mortality rate for SARF-MV patients was 45.0%, with a median ICU survival time of 11.0 days (95% IC 8.6–13.4 days). Additionally, other 10 patients with SARF-MV died in hospital wards after being transferred from ICU; of them, eight patients died from septic shock and two from acute cardiovascular problems, so the hospital mortality rate for SARF-MV patients was 54.1%, with a median hospital survival time of 14.0 days (95% CI 11.2–16.8 days).The Kaplan–Meier method showed that patients with SARF-MV had a decreased ICU (Log-rank test=21.75; p<0.0001) and hospital survival rate (Log-rank test=128.91; p<0.0001) compared with patients without SARF-MV (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A and C). In a subgroup analysis, both surgical and non-surgical patients with SARF-MV had a decreased ICU (Log-rank test=43.19; p<0.0001) and hospital survival rate (Log-rank test=176.06; p<0.0001) compared with patients without SARF-MV (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B and D).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThis retrospective analysis showed that patients with cancer admitted to the ICU had a SARF-MV rate of 15.8%. The need of MV was higher in others studies, accounting for 35–50% of critically ill cancer patients.<a class="elsevierStyleCrossRefs" href="#bib0200">4,11,12</a> These differences with our results appear to derive from differences in the composition of the studied participants. In our study, most patients were admitted to the ICU for elective postoperative care. However, SARF-MV rate in medical patients was comparable to those reported in the international cohorts.<a class="elsevierStyleCrossRefs" href="#bib0245">13,14</a>We found that brain tumour, stage IV of cancer, sepsis at ICU admission and APACHE II score≥20 points were independently associated with SARF-MV. There are not studies in the literature evaluating risk factors for SARF-MV in critically ill cancer patients, so that this is the first study conducted under that purpose.We observed an advanced cancer (tumour stage III or IV) rate of 63.3% for SARF-MV patients. Other authors found similar results. From 53 terminal cancer patients, Singh et al. found a MV rate of 77%.<a class="elsevierStyleCrossRef" href="#bib0255">15</a> In patients with advanced solid cancer admitted to ICU, Xia and Wang observed that 57.4% of them required invasive MV.<a class="elsevierStyleCrossRef" href="#bib0260">16</a> Thus, advanced oncological disease may be related with SARF-MV. This association is explained by several factors such as primary or metastatic pulmonary infiltrates, infectious complication secondary to immunosuppression, organ dysfunction, respiratory muscle weakness due to malnutrition, and drug-induced lung toxicity,<a class="elsevierStyleCrossRefs" href="#bib0200">4,17–19</a> all of which can predispose to SARF-MV.Tumour site such as brain or lung can be a factor related with the need of MV in critically ill cancer patients, which is mainly explained by the local effect of the tumour. Patients with primary lung cancer or secondary pulmonary infiltrates are at high risk of MV as reported in previous studies.<a class="elsevierStyleCrossRefs" href="#bib0195">3,4</a> Pulmonary infiltrates predispose to infection, atelectasis, hemoptysis, pulmonary oedema, and pleural effusion,<a class="elsevierStyleCrossRefs" href="#bib0200">4,5</a> with gas exchange disturbances and a high respiratory muscles work increasing the risk of SARF-MV. On the other hand, we identified that brain tumour was associated with SARF-MV. The most frequent intracranial brain tumours are brain metastases, and all types of cancer can develop this complication. Primary o secondary brain tumours cause brain oedema, intracranial hypertension, alteration in consciousness level, and need of MV.<a class="elsevierStyleCrossRef" href="#bib0280">20</a> In addition, some intervention such as neurosurgery or chemotherapy also would explain the higher rates of MV. Yutaka et al. observed that neurosurgery for brain tumour was associated with the need of MV.<a class="elsevierStyleCrossRef" href="#bib0285">21</a> Flexman et al. reported similar results.<a class="elsevierStyleCrossRef" href="#bib0290">22</a> Chemotherapy may have detrimental effects on central nervous system. Central nervous system neurotoxicity resulting from chemotherapy manifests as a wide range of clinical syndromes including acute, subacute, and chronic encephalopathies, posterior reversible encephalopathy, acute cerebellar dysfunction, chronic cognitive impairment, myelopathy, meningitis, and neurovascular syndromes.<a class="elsevierStyleCrossRef" href="#bib0295">23</a> So that, MV would be required as supportive therapy for these clinical entities, which vary by causative agent, degree of severity, evolution, and timing of occurrence.Sepsis affects the respiratory muscle because of muscular autophagy, dysfunction, decreased synthesis, and degradation of contractile proteins.<a class="elsevierStyleCrossRefs" href="#bib0300">24,25</a> More than fifteen years ago, Soares et al. identified that 63% of cancer patients requiring mechanical ventilatory support for more than 24h had sepsis.<a class="elsevierStyleCrossRef" href="#bib0310">26</a> Recently, Yoo et al. also observed an infectious aetiology rate of 64% for cancer patients with diffuse pulmonary infiltrates causing acute respiratory failure admitted in ICU.<a class="elsevierStyleCrossRef" href="#bib0200">4</a> We identified that sepsis was an independent factor associated with increased risk of SARF-MV, which suggests that sepsis acts as early prognostic factor in cancer patients admitted in ICU as observed in critically ill non-cancer patients.<a class="elsevierStyleCrossRef" href="#bib0315">27</a>The APACHE II score was associated with SARF-MV. This model was developed for mortality prediction,<a class="elsevierStyleCrossRef" href="#bib0320">28</a> but higher values indicate a greater severity of illness. Hence, the underlying pathophysiological disturbances may be associated with pulmonary damage and need of MV in critically ill cancer patients.According to methodological design and included patients in previous studies, the ICU mortality rate and the hospital mortality rate in cancer patients range between 30% and 77%,<a class="elsevierStyleCrossRefs" href="#bib0185">1,15</a> and 30% and 56%,<a class="elsevierStyleCrossRefs" href="#bib0195">3,29</a> respectively. Over time, however, mortality rates have decreased.<a class="elsevierStyleCrossRef" href="#bib0330">30</a>In ventilated cancer patients, some studies have shown an ICU mortality rate and a hospital mortality rate greater than 50%,<a class="elsevierStyleCrossRefs" href="#bib0235">11,26</a> and 65%,<a class="elsevierStyleCrossRefs" href="#bib0235">11,26,31</a> respectively. We observed a similar mortality rate for SARF-MV patients. SARF-MV is known as a risk factor for mortality in non-cancer patients<a class="elsevierStyleCrossRef" href="#bib0340">32</a>; however, their effect on outcomes has not been completely established for critically ill cancer subpopulation before.MV is a temporary life-support method; however, despite the benefits of this therapy, many patients die after the initiation of mechanical ventilation, even though their arterial blood gases may have normalized. Mortality associated with SARF-MV can be associated with multiple factors including complications of ventilation such as barotrauma, oxygen toxicity, haemodynamic compromise, and ventilator-induced lung injury,<a class="elsevierStyleCrossRefs" href="#bib0345">33–35</a> as well as infectious complication such as ventilator-associated pneumonia.<a class="elsevierStyleCrossRef" href="#bib0360">36</a> In cancer patients the local and systemic effects of tumour may play an additional role.The length of hospital stay was similar between those patients with SARF-VM and those patients without SARF-VM. This is because higher hospital mortality rate among those subjects with SARF-VM, which in fact, died earlier. So that, the median length of hospital stay for ventilated patients was close to the median length of hospital stay for non-ventilated patients.The present study has several shortcomings. First, our study was conducted at a single institution confined to oncological patients with a specialized ICU for critically ill cancer patients. Additionally, most patients were admitted to the ICU for postoperative care. Therefore, results of this study can only be applicable to other centres in which experienced intensivists are available for oncological and surgical critical care. Secondly, although data were extracted from a prospective database, given its retrospective nature, selection bias may have influenced our findings.Results of this study demonstrated a significant association between some clinical factors with SARF-MV in cancer patients including primary tumour location, clinical stage of cancer, sepsis and APACHE II score. Our finding also highlights the powerful effect of SARF-MV on outcomes. However, this observation needs to be further evaluated by a multicentre, prospective study.Author's contributionFDMB contributed in the Concepts, Design, Definition of intellectual content, Literature search, Clinical studies, Experimental studies, Data acquisition, Data analysis, Statistical analysis, Manuscript preparation, Manuscript editing, Manuscript review.AGN contributed in the Design, Definition of intellectual content, Clinical studies, Data acquisition, Manuscript editing, Manuscript review.MB contributed in the Literature search, Data analysis, Manuscript preparation, Manuscript editing, Manuscript review.NAD contributed in the Literature search, Data analysis, Manuscript preparation, Manuscript editing, Manuscript review.Conflict of interestsThere are no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1063661" "titulo" => "Abstract" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Variables" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1011811" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1063662" "titulo" => "Resumen" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Contexto" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Pacientes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1011814" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design and setting" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Participants" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Data collection and outcomes" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Characteristics of study population" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Risk factors for SARF-MV" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Outcomes of patients with SARF-MV" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Author's contribution" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 10 => array:2 [ "identificador" => "xack360009" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-06-17" "fechaAceptado" => "2017-08-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1011811" "palabras" => array:7 [ 0 => "Acute respiratory failure" 1 => "APACHE" 2 => "Cancer" 3 => "Critically ill cancer patient" 4 => "Mortality" 5 => "Mechanical ventilation" 6 => "Sepsis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1011814" "palabras" => array:7 [ 0 => "Insuficiencia respiratoria aguda" 1 => "APACHE" 2 => "Cáncer" 3 => "Paciente oncológico crítico" 4 => "Mortalidad" 5 => "Ventilación mecánica" 6 => "Sepsis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesTo determine the risk factors for severe acute respiratory failure requiring invasive mechanical ventilation (SARF-MV) and its effect upon clinical outcomes in critically ill cancer patients. DesignA retrospective cohort study was carried out. SettingA 12-bed oncological intensive care unit (ICU) from January 2014 to December 2015. PatientsA total of 878 consecutive cancer patients were included. Patients with an ICU stay of ≤1 day were excluded. The final sample size was 691 patients. InterventionsNone. VariablesClinical variables at ICU admission were extracted from the medical records. The primary outcome was SARF-MV. We also measured ICU and hospital mortality, as well as length of stay. ResultsThe SARF-MV rate was 15.8%. The multivariate analysis identified brain tumour (OR 14.54; 95%CI 3.86–54.77; p<0.0001), stage IV cancer (OR 3.47; 95%CI 1.26–9.54; p=0.016), sepsis upon admission (OR 2.28; 95%CI 1.14–4.56; p=0.020) and an APACHE II score≥20 points (OR 5.38; 95%CI 1.92–15.05; p=0.001) as being independently associated to SARF-MV. Compared with the patients without SARF-MV, those with SARF-MV had a prolonged length of ICU stay (p<0.0001), a lower ICU survival rate (p<0.0001) and a lower hospital survival rate (p<0.0001). ConclusionsA number of clinical factors are related to SARF-MV. In this regard, SARF-MV is a powerful factor independently correlated to poor outcomes. Future studies should investigate means for preventing SARF-MV in critically ill cancer patients, which may have an impact upon outcomes." "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Variables" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosDeterminar los factores de riesgo para insuficiencia respiratoria grave que requiere ventilación mecánica (IRG-VM) y sus efectos sobre los resultados clínicos en pacientes críticos con cáncer. DiseñoEstudio de cohorte retrospectivo. ContextoDesde enero de 2014 a diciembre de 2015 en una unidad de cuidados intensivos (UCI) oncológicos de 12 camas. PacientesSe incluyeron consecutivamente 878 pacientes. Se excluyeron aquellos con una estancia en UCI≤un día. Finalmente la muestra fue de 691. IntervencionesNinguna. VariablesDe los registros médicos se extrajeron las variables clínicas a la admisión en UCI. La variable de respuesta primaria fue la IRG-VM. También se analizó la mortalidad y estancia en UCI/hospitalaria. ResultadosLa tasa de IRG-VM fue del 15,8%. En el análisis multivariado el tumor cerebral (OR 14,54; IC 95% 3,86-54,77; p<0,0001), la etapa IV del cáncer (OR 3,47; IC 95% 1,26-9,54; p=0,016), la sepsis (OR 2,28; IC 95% 1,14-4,56; p=0,020) y la escala APACHE II≥20 puntos (OR 5,38; IC 95% 1,92-15,05; p=0,001) fueron factores de riesgo independientes de IRG-VM. La IRG-VM se asoció con una mayor estancia en la UCI (p<0,0001), así como con una menor tasa de supervivencia en UCI (p<0,0001) y hospitalaria (p<0,0001). ConclusionesAlgunos factores clínicos se relacionan con la IRG-VM. Este trastorno es un factor que se relaciona poderosamente con un peor pronóstico. Se requieren estudios futuros que investiguen las formas de prevención de la IRG-VM en los pacientes oncológicos críticos, lo cual podría tener un impacto en los resultados." "secciones" => array:8 [ 0 => array:2 [ "identificador" => "abst0045" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0050" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0055" "titulo" => "Contexto" ] 3 => array:2 [ "identificador" => "abst0060" "titulo" => "Pacientes" ] 4 => array:2 [ "identificador" => "abst0065" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0070" "titulo" => "Variables" ] 6 => array:2 [ "identificador" => "abst0075" "titulo" => "Resultados" ] 7 => array:2 [ "identificador" => "abst0080" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1625 "Ancho" => 1667 "Tamanyo" => 99552 ] ] "descripcion" => array:1 [ "en" => "Flow diagram of study participants. ICU: intensive care unit." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 952 "Ancho" => 1688 "Tamanyo" => 86291 ] ] "descripcion" => array:1 [ "en" => "Causes of severe acute respiratory failure requiring invasive mechanical ventilation." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2469 "Ancho" => 3078 "Tamanyo" => 333617 ] ] "descripcion" => array:1 [ "en" => "Kaplan–Meier analysis depicting the impact of severe acute respiratory failure requiring invasive mechanical ventilation on intensive care unit survival – all patients (A), intensive care unit survival – subgroup patients (B), hospital survival – all patients (C), and hospital survival – subgroup patients (D). SARF-MV: severe acute respiratory failure requiring invasive mechanical ventilation." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "APACHE: acute physiology and chronic health evaluation; IQR: 25th to 75th interquartile rank; SARF-MV: severe acute respiratory failure requiring invasive mechanical ventilation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SARF-MV N=109 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-SARF-MV N=582 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age, years (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.0 (45.5–67.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.5 (52.0–70.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Age, n (%)</td><td class="td" title="table-entry " align="char" valign="top">0.041 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (7.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">30–39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">40–49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">50–59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (22.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">153 (26.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">60–69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (28.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">173 (29.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (19.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">147 (25.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender (male), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 (56.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">275 (47.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.065 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Primary tumour location, n (%)</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Head and neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (8.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thorax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (20.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 (25.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrointestinal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (22.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">215 (36.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gynaecological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (8.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (6.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haematological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (11.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brain<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (9.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breast \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (2.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (6.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Clinical stage of cancer, n (%)</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (5.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 (13.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (31.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">257 (44.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (27.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">124 (21.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (35.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">121 (20.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age-Adjusted Charlson Comorbidity Index, points (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0 (2.0–5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0 (2.0–5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.875 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Age-Adjusted Charlson Comorbidity Index, n (%)</td><td class="td" title="table-entry " align="char" valign="top">0.608 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0–1 point \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 (16.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (13.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2–3 points \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">39 (35.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">237 (40.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4–5 points \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (29.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">178 (30.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥6 points \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (18.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91 (15.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Origin (emergency department), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (23.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 (7.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Type of admission (medical), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">46 (42.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 (17.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malignancy-unrelated admission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (33.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 (15.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Transfusion of blood products, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (29.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">148 (25.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.391 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (21.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (5.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Adverse event to chemotherapy, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (4.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">APACHE II score, points (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.0 (10.4–16.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.0 (10.0–13.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">APACHE II score, n (%)</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><10 points \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (14.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">125 (21.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10–14 points \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (48.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">357 (61.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15–19 points \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (23.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88 (15.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥20 points \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1813700.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "It includes cancer of skull base." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Primary unknown (5 cases), retroperitoneum (10 cases), melanoma (4 cases), limbs (11 cases), others (13 cases)." ] ] ] "descripcion" => array:1 [ "en" => "Univariate analysis of factors associated with severe acute respiratory failure requiring invasive mechanical ventilation." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "APACHE: acute physiology and chronic health evaluation; CI: confidence interval; OR: odds ratio; Ref.: reference category." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender, male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.93–2.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.092 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Primary tumour location</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Head and neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ref. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(–) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Thorax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.44–2.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.892 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gastrointestinal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.31–1.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.532 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gynaecological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.34–3.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.967 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.33–3.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.912 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haematological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57–4.99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.342 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Brain<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.86–54.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Breast \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.30–4.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.806 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.18–1.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.393 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Clinical stage of cancer</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ref. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(–) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.026 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.61–4.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.319 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.91–7.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.073 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.26–9.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.14–4.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.020 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">APACHE II score, points</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ref. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">(–) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10–14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57–2.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.807 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15–19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.86–3.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.117 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.92–15.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1813699.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "[Hosmer–Lemeshow χ2: 5.60; p=0.692. Area under ROC curve: 0.75 (95% CI 0.70–0.80); p<0.0001]." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "It includes cancer of skull base." ] 2 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "c" "nota" => "Cancer of primary unknown, retroperitoneum, melanoma, limbs, others." ] ] ] "descripcion" => array:1 [ "en" => "Results of multivariate logistic regression analysis<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> of factors associated with severe acute respiratory failure requiring invasive mechanical ventilation." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "IQR: 25th to 75th interquartile rank; ICU: intensive care unit; SARF-MV: severe acute respiratory failure requiring invasive mechanical ventilation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SARF-MV N=109 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-SARF-MV N=582 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of ICU stay, days (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.0 (3.0–9.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.0 (2.0–4.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ICU mortality, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (45.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (4.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of hospital stay, days (IQR) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.0 (6.0–14.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.0 (6.0–13.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.967 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In-hospital mortality, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (54.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (6.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1813702.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Outcomes of patients with severe acute respiratory failure requiring invasive mechanical ventilation." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0185" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic factors in critically ill cancer patients admitted to the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Aygencel" 1 => "M. Turkoglu" 2 => "G. Turkoz" 3 => "M. Benekli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrc.2014.01.014" "Revista" => array:6 [ "tituloSerie" => "J Crit Care" "fecha" => "2014" "volumen" => "29" "paginaInicial" => "618" "paginaFinal" => "626" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24612762" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0190" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retrospective analysis of outcome of women with breast or gynaecological cancer in the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Ostermann" 1 => "M. Raimundo" 2 => "A. Williams" 3 => "C. Whiteley" 4 => "R. 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Risk factors and outcomes of severe acute respiratory failure requiring invasive mechanical ventilation in cancer patients: A retrospective cohort study

Factores de riesgo y resultados de la insuficiencia respiratoria grave que requiere ventilación mecánica invasiva en pacientes oncológicos: un estudio de cohortes retrospectivo

F.D. Martos-Benítez

Corresponding author

fdmartos@infomed.sld.cu

Corresponding author.

, A. Gutiérrez-Noyola, M. Badal, N.A. Dietrich

Department of Intensive Care, Institute of Oncology and Radiobiology, 29 Street, Vedado, Havana, Cuba

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    "titulo" => "Risk factors and outcomes of severe acute respiratory failure requiring invasive mechanical ventilation in cancer patients&#58; A retrospective cohort study"
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Causes of severe acute respiratory failure requiring invasive mechanical ventilation&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acute respiratory failure &#40;ARF&#41; is a frequent disorder in cancer patients&#44; commonly caused by several conditions including local effect of tumour&#44; pulmonary infiltrates&#44; pneumonia&#44; acute respiratory distress syndrome and congestive heart failure&#46; Supplemental oxygen and treatment of the underlying disorder is the mainstay of treatment for ARF&#44; but severe cases require ventilatory support&#46; Indeed&#44; the need of this treatment modality is one of most frequent reasons for admission in the intensive care unit &#40;ICU&#41; for critically ill cancer patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Mechanical ventilation &#40;MV&#41; is a primary method of organic function support in critically ill cancer patients treated in ICU&#44; usually indicating a severe ARF &#40;SARF&#41;&#46; However&#44; despite significant advances in ventilatory support and cancer management&#44; MV remains associated with a high ICU&#44; hospital and long-term mortality rate&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;5</span></a> In addition&#44; the need of MV because of postoperative respiratory failure in operated cancer patients has been reported as high as 37&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> which is associated with unfavourable outcomes as well&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although some previous studies have reported an association between SARF and VM with mortality in critically ill cancer patients&#44; this relation is not clear because of methodological designs&#44; participants&#8217; characteristics and limitations of the studies&#46; Conversely&#44; the risk factors for SARF have not been consistently investigated in this type of patients&#46; The study was aimed&#58; 1&#41; to identify the risk factors for severe acute respiratory failure requiring invasive mechanical ventilation &#40;SARF-MV&#41;&#59; and 2&#41; to determine the effects of SARF-MV on clinical outcomes in cancer patients admitted in an oncological ICU&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Design and setting</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a retrospective cohort study conducted in the oncological ICU of the Institute of Oncology and Radiobiology &#40;IOR&#41;&#46; This is a 220-bed&#44; university-affiliated&#44; tertiary care referral centre for cancer patients in Havana&#44; Cuba&#46; The ICU has 12 beds and provides care for about 500 medical and surgical cancer patients per year&#46; Data source was the prospective database of the ICU and hospital records &#40;January 2014&#8211;December 2015&#41;&#46; The study was approved by the Scientific Council and the Ethics Committee for Scientific Research of the IOR&#46; Informed consent was waivered because of the retrospective nature of the study&#46; It was conducted in accordance with the Declaration of Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Participants</span><p id="par0025" class="elsevierStylePara elsevierViewall">Over the study period&#44; a total of 878 consecutive cancer patients were included&#46; Patients with a length of ICU stay &#8804;1 day were excluded &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">For those patients who were admitted more than once to the ICU during the same hospitalization&#44; only the first data on ICU admission were analyzed&#46; To be admitted&#44; the oncologist and the ICU physician generally were agreed that patients had a potential chance of recovering from the acute problem&#46; In contrast&#44; patients without any further oncology specific treatment options were offered end-of-life care on the referring ward and not transferred to the ICU&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Data collection and outcomes</span><p id="par0035" class="elsevierStylePara elsevierViewall">The following variables on ICU admission were extracted from the medical records&#58; age&#44; sex&#44; Age-Adjusted Charlson Comorbidity Index score with the exclusion of malignancy&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a> primary tumour location&#44; clinical stage of cancer&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> patient origin &#40;hospital ward or emergency department&#41;&#44; malignancy-unrelated admission&#44; type of admission &#40;medical or surgical&#41;&#44; emergency surgery&#44; Acute Physiology and Chronic Health Evaluation &#40;APACHE&#41; II score&#44; transfusion of blood products within 15 days prior to ICU admission&#44; sepsis according to the Surviving Sepsis Campaign&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">10</span></a> and adverse event to chemotherapy as cause for admission in ICU&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The outcome of interest was the SARF-MV&#44; defined as the need of invasive mechanical ventilation because of the presence of respiratory distress symptoms such as tachypnea &#40;respiratory rate<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>min<span class="elsevierStyleSup">&#8211;1</span>&#41;&#44; an arterial partial pressure of oxygen &#40;PaO<span class="elsevierStyleInf">2</span>&#41;&#47;fraction of inspired oxygen &#40;FiO<span class="elsevierStyleInf">2</span>&#41; ratio<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>300<span class="elsevierStyleHsp" style=""></span>mmHg or hypercapnia with abnormal mental status&#46; We also assessed the effect of SARF-MV on clinical outcomes such as length of ICU and hospital stay&#44; as well as ICU and hospital mortality&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Categorical variables are showed as count with percentage and numerical variables as median with 25th to 75th interquartile range &#40;IQR&#41;&#46; Difference between groups was performed using Pearson&#39;s chi-square test &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#41; or Fisher&#39;s exact test as appropriated for categorical variables&#59; because of lack of normality&#44; the Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used for numerical variables&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Multivariate logistic regression model was used to identify risk factors associated with SARF-MV&#46; Explanatory variables yielding <span class="elsevierStyleItalic">p</span>-values<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 by univariate analysis and those clinically relevant were considered to enter in the initial model&#46; Parsimony of the model was guaranteed&#46; Because of lack of normality&#44; numerical variables were stratified according to the analysis of the functional form and clinical significance&#46; Development of model was based on backward stepwise &#40;likelihood ratio&#41; significance testing &#40;<span class="elsevierStyleItalic">p</span>-value to enter&#58; 0&#46;10&#59; <span class="elsevierStyleItalic">p</span>-value to remove&#58; 0&#46;15&#41;&#46; The Hosmer&#8211;Lemeshow test was used to check the goodness of fit&#46; Discrimination capability was evaluated by determination of the area under the receiver operating characteristic &#40;ROC&#41; curve&#46; Results were summarized as odds ratio &#40;OR&#41; and respective 95&#37; confidence interval &#40;CI&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The survival was estimated by the Kaplan&#8211;Meier method&#46; The follow-up time was marked by the date of ICU admission and by the date of hospital discharge&#46; The survival rate was compared using the log-rank test&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical test with a two tailed <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered as significant&#46; Data were analyzed using IBM<span class="elsevierStyleSup">&#174;</span> SPSS<span class="elsevierStyleSup">&#174;</span> Statistics 21&#46;0 &#40;IBM&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Characteristics of study population</span><p id="par0065" class="elsevierStylePara elsevierViewall">A total of 691 patients were analyzed &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The main characteristics of study population are depicted in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Patients with history of chronic disease were 468 &#40;67&#46;7&#37;&#41;&#46; The median in the Age-Adjusted Charlson Comorbidity Index score was 3&#46;0 points &#40;IQR 2&#46;0&#8211;5&#46;0 points&#41;&#59; a score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>2 points was observed in 86&#46;4&#37; of subjects&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Postoperative care was the most common cause for admission in ICU &#40;78&#46;6&#37;&#41;&#46; Gastrointestinal tract &#40;46&#46;6&#37;&#41; and thorax &#40;27&#46;4&#37;&#41; were the most frequent sites for surgical interventions&#46; The emergency surgery was carried out in 5&#46;5&#37; of the operated patients&#46; The most common causes for admission in ICU in medical patients were acute respiratory failure &#40;32&#46;4&#37;&#41;&#44; infections &#40;30&#46;4&#37;&#41;&#44; cardiovascular disorders &#40;19&#46;6&#37;&#41;&#44; neurological disorders &#40;9&#46;5&#37;&#41;&#44; and others &#40;8&#46;1&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Probability of death estimated by APACHE II was 11&#46;7&#37; &#40;IQR 8&#46;5&#8211;18&#46;5&#37;&#41;&#46; Eighty-one patients &#40;11&#46;7&#37;&#41; required vasopressors during their stay in ICU&#46; Thirty-four patients &#40;4&#46;9&#37;&#41; were re-admitted to ICU during the same hospitalization&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Risk factors for SARF-MV</span><p id="par0080" class="elsevierStylePara elsevierViewall">A total of 109 patients &#40;15&#46;8&#37;&#41; developed SARF-MV&#46; The SARF-MV rate was 31&#46;1&#37; for medical patients and 11&#46;6&#37; for surgical patients&#46; ARF secondary to non-pulmonary sepsis &#40;31&#46;2&#37;&#41; such as peritonitis &#40;25 cases&#41;&#44; urinary tract infection &#40;two cases&#41;&#44; soft tissue infection &#40;six cases&#41; and central nervous system infection &#40;one case&#41;&#44; as well as pneumonia &#40;22&#46;9&#37;&#41; were the main causes of SARF-MV&#46; Other causes were postoperative respiratory failure &#40;18&#46;3&#37;&#41; because of difficult weaning &#40;seven cases&#41;&#44; circulatory instability &#40;six&#41;&#44; atelectasis &#40;two cases&#41; or volume overload &#40;five cases&#41;&#59; non-septic neurological disorders &#40;11&#46;0&#37;&#41; such as brain metastasis &#40;four cases&#41;&#44; ischaemic stroke &#40;five cases&#41; or brain haemorrhage &#40;three cases&#41;&#59; cardiovascular disorders &#40;10&#46;1&#37;&#41; such as acute pulmonary embolism &#40;four cases&#41;&#44; acute myocardial infarction &#40;three cases&#41;&#44; acute pulmonary oedema &#40;two cases&#41; or haemorrhage &#40;two cases&#41;&#59; and non-septic pulmonary disorders &#40;6&#46;4&#37;&#41; such as aspiration &#40;two cases&#41; or acute respiratory distress syndrome because of pancreatitis &#40;one case&#41; and drugs reaction &#40;four cases&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">In the univariate analysis&#44; primary tumour location&#44; clinical stage of cancer&#44; admission from the emergency department&#44; medical admission&#44; malignancy-unrelated admission&#44; sepsis&#44; adverse event to chemotherapy&#44; and APACHE II score were related with SARF-MV &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In multivariate logistic regression analysis&#44; brain tumour&#44; stage IV-cancer&#44; sepsis at ICU admission&#44; and APACHE II score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>20 points were independently associated with increased risk of SARF-MV &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Outcomes of patients with SARF-MV</span><p id="par0095" class="elsevierStylePara elsevierViewall">The overall ICU and hospital mortality rate was 10&#46;9&#37; and 14&#46;0&#37;&#44; respectively&#46; Median length of ICU and hospital stay was 3&#46;0 days &#40;IQR 2&#46;0&#8211;4&#46;0 days&#41; and 9&#46;0 days &#40;IQR 6&#46;0&#8211;13&#46;0 days&#41;&#44; respectively&#46; Compared with patients without respiratory failure&#44; those with SARF-MV had a prolonged length of ICU stay &#40;Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; an increased ICU mortality rate &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>155&#46;53&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; and an increased hospital mortality rate &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>172&#46;37&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The median ICU and hospital survival time of the total cohort was 14&#46;0 days &#40;95&#37; CI 11&#46;4&#8211;16&#46;6 days&#41; and 39&#46;0 days &#40;95&#37; CI 34&#46;6&#8211;43&#46;4 days&#41;&#44; respectively&#46; Of the 109 patients with SARF-MV&#44; 49 died in ICU&#46; Of the 49 patients&#44; 27 died from septic shock&#44; 10 from respiratory failure&#44; six from neurological disorders&#44; five from cardiogenic shock&#44; and one from hypovolemic shock due to haemorrhage&#46; Therefore&#44; the ICU mortality rate for SARF-MV patients was 45&#46;0&#37;&#44; with a median ICU survival time of 11&#46;0 days &#40;95&#37; IC 8&#46;6&#8211;13&#46;4 days&#41;&#46; Additionally&#44; other 10 patients with SARF-MV died in hospital wards after being transferred from ICU&#59; of them&#44; eight patients died from septic shock and two from acute cardiovascular problems&#44; so the hospital mortality rate for SARF-MV patients was 54&#46;1&#37;&#44; with a median hospital survival time of 14&#46;0 days &#40;95&#37; CI 11&#46;2&#8211;16&#46;8 days&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The Kaplan&#8211;Meier method showed that patients with SARF-MV had a decreased ICU &#40;Log-rank test<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#46;75&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and hospital survival rate &#40;Log-rank test<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>128&#46;91&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; compared with patients without SARF-MV &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A and C&#41;&#46; In a subgroup analysis&#44; both surgical and non-surgical patients with SARF-MV had a decreased ICU &#40;Log-rank test<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#46;19&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and hospital survival rate &#40;Log-rank test<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>176&#46;06&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; compared with patients without SARF-MV &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>B and D&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">This retrospective analysis showed that patients with cancer admitted to the ICU had a SARF-MV rate of 15&#46;8&#37;&#46; The need of MV was higher in others studies&#44; accounting for 35&#8211;50&#37; of critically ill cancer patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;11&#44;12</span></a> These differences with our results appear to derive from differences in the composition of the studied participants&#46; In our study&#44; most patients were admitted to the ICU for elective postoperative care&#46; However&#44; SARF-MV rate in medical patients was comparable to those reported in the international cohorts&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">We found that brain tumour&#44; stage IV of cancer&#44; sepsis at ICU admission and APACHE II score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>20 points were independently associated with SARF-MV&#46; There are not studies in the literature evaluating risk factors for SARF-MV in critically ill cancer patients&#44; so that this is the first study conducted under that purpose&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">We observed an advanced cancer &#40;tumour stage III or IV&#41; rate of 63&#46;3&#37; for SARF-MV patients&#46; Other authors found similar results&#46; From 53 terminal cancer patients&#44; Singh et al&#46; found a MV rate of 77&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a> In patients with advanced solid cancer admitted to ICU&#44; Xia and Wang observed that 57&#46;4&#37; of them required invasive MV&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> Thus&#44; advanced oncological disease may be related with SARF-MV&#46; This association is explained by several factors such as primary or metastatic pulmonary infiltrates&#44; infectious complication secondary to immunosuppression&#44; organ dysfunction&#44; respiratory muscle weakness due to malnutrition&#44; and drug-induced lung toxicity&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;17&#8211;19</span></a> all of which can predispose to SARF-MV&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Tumour site such as brain or lung can be a factor related with the need of MV in critically ill cancer patients&#44; which is mainly explained by the local effect of the tumour&#46; Patients with primary lung cancer or secondary pulmonary infiltrates are at high risk of MV as reported in previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3&#44;4</span></a> Pulmonary infiltrates predispose to infection&#44; atelectasis&#44; hemoptysis&#44; pulmonary oedema&#44; and pleural effusion&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;5</span></a> with gas exchange disturbances and a high respiratory muscles work increasing the risk of SARF-MV&#46; On the other hand&#44; we identified that brain tumour was associated with SARF-MV&#46; The most frequent intracranial brain tumours are brain metastases&#44; and all types of cancer can develop this complication&#46; Primary o secondary brain tumours cause brain oedema&#44; intracranial hypertension&#44; alteration in consciousness level&#44; and need of MV&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> In addition&#44; some intervention such as neurosurgery or chemotherapy also would explain the higher rates of MV&#46; Yutaka et al&#46; observed that neurosurgery for brain tumour was associated with the need of MV&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> Flexman et al&#46; reported similar results&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">22</span></a> Chemotherapy may have detrimental effects on central nervous system&#46; Central nervous system neurotoxicity resulting from chemotherapy manifests as a wide range of clinical syndromes including acute&#44; subacute&#44; and chronic encephalopathies&#44; posterior reversible encephalopathy&#44; acute cerebellar dysfunction&#44; chronic cognitive impairment&#44; myelopathy&#44; meningitis&#44; and neurovascular syndromes&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a> So that&#44; MV would be required as supportive therapy for these clinical entities&#44; which vary by causative agent&#44; degree of severity&#44; evolution&#44; and timing of occurrence&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Sepsis affects the respiratory muscle because of muscular autophagy&#44; dysfunction&#44; decreased synthesis&#44; and degradation of contractile proteins&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">24&#44;25</span></a> More than fifteen years ago&#44; Soares et al&#46; identified that 63&#37; of cancer patients requiring mechanical ventilatory support for more than 24<span class="elsevierStyleHsp" style=""></span>h had sepsis&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> Recently&#44; Yoo et al&#46; also observed an infectious aetiology rate of 64&#37; for cancer patients with diffuse pulmonary infiltrates causing acute respiratory failure admitted in ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> We identified that sepsis was an independent factor associated with increased risk of SARF-MV&#44; which suggests that sepsis acts as early prognostic factor in cancer patients admitted in ICU as observed in critically ill non-cancer patients&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">The APACHE II score was associated with SARF-MV&#46; This model was developed for mortality prediction&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> but higher values indicate a greater severity of illness&#46; Hence&#44; the underlying pathophysiological disturbances may be associated with pulmonary damage and need of MV in critically ill cancer patients&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">According to methodological design and included patients in previous studies&#44; the ICU mortality rate and the hospital mortality rate in cancer patients range between 30&#37; and 77&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1&#44;15</span></a> and 30&#37; and 56&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">3&#44;29</span></a> respectively&#46; Over time&#44; however&#44; mortality rates have decreased&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">In ventilated cancer patients&#44; some studies have shown an ICU mortality rate and a hospital mortality rate greater than 50&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">11&#44;26</span></a> and 65&#37;&#44;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">11&#44;26&#44;31</span></a> respectively&#46; We observed a similar mortality rate for SARF-MV patients&#46; SARF-MV is known as a risk factor for mortality in non-cancer patients<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a>&#59; however&#44; their effect on outcomes has not been completely established for critically ill cancer subpopulation before&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">MV is a temporary life-support method&#59; however&#44; despite the benefits of this therapy&#44; many patients die after the initiation of mechanical ventilation&#44; even though their arterial blood gases may have normalized&#46; Mortality associated with SARF-MV can be associated with multiple factors including complications of ventilation such as barotrauma&#44; oxygen toxicity&#44; haemodynamic compromise&#44; and ventilator-induced lung injury&#44;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">33&#8211;35</span></a> as well as infectious complication such as ventilator-associated pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> In cancer patients the local and systemic effects of tumour may play an additional role&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The length of hospital stay was similar between those patients with SARF-VM and those patients without SARF-VM&#46; This is because higher hospital mortality rate among those subjects with SARF-VM&#44; which in fact&#44; died earlier&#46; So that&#44; the median length of hospital stay for ventilated patients was close to the median length of hospital stay for non-ventilated patients&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The present study has several shortcomings&#46; First&#44; our study was conducted at a single institution confined to oncological patients with a specialized ICU for critically ill cancer patients&#46; Additionally&#44; most patients were admitted to the ICU for postoperative care&#46; Therefore&#44; results of this study can only be applicable to other centres in which experienced intensivists are available for oncological and surgical critical care&#46; Secondly&#44; although data were extracted from a prospective database&#44; given its retrospective nature&#44; selection bias may have influenced our findings&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Results of this study demonstrated a significant association between some clinical factors with SARF-MV in cancer patients including primary tumour location&#44; clinical stage of cancer&#44; sepsis and APACHE II score&#46; Our finding also highlights the powerful effect of SARF-MV on outcomes&#46; However&#44; this observation needs to be further evaluated by a multicentre&#44; prospective study&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Author&#39;s contribution</span><p id="par0170" class="elsevierStylePara elsevierViewall">FDMB contributed in the Concepts&#44; Design&#44; Definition of intellectual content&#44; Literature search&#44; Clinical studies&#44; Experimental studies&#44; Data acquisition&#44; Data analysis&#44; Statistical analysis&#44; Manuscript preparation&#44; Manuscript editing&#44; Manuscript review&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">AGN contributed in the Design&#44; Definition of intellectual content&#44; Clinical studies&#44; Data acquisition&#44; Manuscript editing&#44; Manuscript review&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">MB contributed in the Literature search&#44; Data analysis&#44; Manuscript preparation&#44; Manuscript editing&#44; Manuscript review&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">NAD contributed in the Literature search&#44; Data analysis&#44; Manuscript preparation&#44; Manuscript editing&#44; Manuscript review&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflict of interests</span><p id="par0190" class="elsevierStylePara elsevierViewall">There are no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the risk factors for severe acute respiratory failure requiring invasive mechanical ventilation &#40;SARF-MV&#41; and its effect upon clinical outcomes in critically ill cancer patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective cohort study was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A 12-bed oncological intensive care unit &#40;ICU&#41; from January 2014 to December 2015&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 878 consecutive cancer patients were included&#46; Patients with an ICU stay of &#8804;1 day were excluded&#46; The final sample size was 691 patients&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">None&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Variables</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Clinical variables at ICU admission were extracted from the medical records&#46; The primary outcome was SARF-MV&#46; We also measured ICU and hospital mortality&#44; as well as length of stay&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The SARF-MV rate was 15&#46;8&#37;&#46; The multivariate analysis identified brain tumour &#40;OR 14&#46;54&#59; 95&#37;CI 3&#46;86&#8211;54&#46;77&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; stage IV cancer &#40;OR 3&#46;47&#59; 95&#37;CI 1&#46;26&#8211;9&#46;54&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#41;&#44; sepsis upon admission &#40;OR 2&#46;28&#59; 95&#37;CI 1&#46;14&#8211;4&#46;56&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;020&#41; and an APACHE II score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>20 points &#40;OR 5&#46;38&#59; 95&#37;CI 1&#46;92&#8211;15&#46;05&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; as being independently associated to SARF-MV&#46; Compared with the patients without SARF-MV&#44; those with SARF-MV had a prolonged length of ICU stay &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; a lower ICU survival rate &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and a lower hospital survival rate &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A number of clinical factors are related to SARF-MV&#46; In this regard&#44; SARF-MV is a powerful factor independently correlated to poor outcomes&#46; Future studies should investigate means for preventing SARF-MV in critically ill cancer patients&#44; which may have an impact upon outcomes&#46;</p></span>"
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        "resumen" => "<span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Objetivos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Determinar los factores de riesgo para insuficiencia respiratoria grave que requiere ventilaci&#243;n mec&#225;nica &#40;IRG-VM&#41; y sus efectos sobre los resultados cl&#237;nicos en pacientes cr&#237;ticos con c&#225;ncer&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Dise&#241;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohorte retrospectivo&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Contexto</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Desde enero de 2014 a diciembre de 2015 en una unidad de cuidados intensivos &#40;UCI&#41; oncol&#243;gicos de 12 camas&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron consecutivamente 878 pacientes&#46; Se excluyeron aquellos con una estancia en UCI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>un d&#237;a&#46; Finalmente la muestra fue de 691&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Ninguna&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Variables</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">De los registros m&#233;dicos se extrajeron las variables cl&#237;nicas a la admisi&#243;n en UCI&#46; La variable de respuesta primaria fue la IRG-VM&#46; Tambi&#233;n se analiz&#243; la mortalidad y estancia en UCI&#47;hospitalaria&#46;</p></span> <span id="abst0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La tasa de IRG-VM fue del 15&#44;8&#37;&#46; En el an&#225;lisis multivariado el tumor cerebral &#40;OR 14&#44;54&#59; IC 95&#37; 3&#44;86-54&#44;77&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; la etapa IV del c&#225;ncer &#40;OR 3&#44;47&#59; IC 95&#37; 1&#44;26-9&#44;54&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;016&#41;&#44; la sepsis &#40;OR 2&#44;28&#59; IC 95&#37; 1&#44;14-4&#44;56&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;020&#41; y la escala APACHE II<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>20 puntos &#40;OR 5&#44;38&#59; IC 95&#37; 1&#44;92-15&#44;05&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; fueron factores de riesgo independientes de IRG-VM&#46; La IRG-VM se asoci&#243; con una mayor estancia en la UCI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#44; as&#237; como con una menor tasa de supervivencia en UCI &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y hospitalaria &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p></span> <span id="abst0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Algunos factores cl&#237;nicos se relacionan con la IRG-VM&#46; Este trastorno es un factor que se relaciona poderosamente con un peor pron&#243;stico&#46; Se requieren estudios futuros que investiguen las formas de prevenci&#243;n de la IRG-VM en los pacientes oncol&#243;gicos cr&#237;ticos&#44; lo cual podr&#237;a tener un impacto en los resultados&#46;</p></span>"
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">APACHE&#58; acute physiology and chronic health evaluation&#59; IQR&#58; 25th to 75th interquartile rank&#59; SARF-MV&#58; severe acute respiratory failure requiring invasive mechanical ventilation&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SARF-MV<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-SARF-MV<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>582&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; years &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59&#46;0 &#40;45&#46;5&#8211;67&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;5 &#40;52&#46;0&#8211;70&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;015</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Age&#44; n &#40;&#37;&#41;</span></td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;041</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;7&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30&#8211;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>40&#8211;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;12&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;11&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>50&#8211;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;22&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153 &#40;26&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>60&#8211;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;28&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173 &#40;29&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;19&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147 &#40;25&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gender &#40;male&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62 &#40;56&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">275 &#40;47&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;065&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Primary tumour location&#44; n &#40;&#37;&#41;</span></td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Head and neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Thorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;20&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150 &#40;25&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gastrointestinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;22&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">215 &#40;36&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gynaecological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;8&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Haematological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;11&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Brain<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;9&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;2&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;6&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Clinical stage of cancer&#44; n &#40;&#37;&#41;</span></td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80 &#40;13&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;31&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">257 &#40;44&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;27&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124 &#40;21&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;35&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">121 &#40;20&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age-Adjusted Charlson Comorbidity Index&#44; points &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0 &#40;2&#46;0&#8211;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;0 &#40;2&#46;0&#8211;5&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;875&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Age-Adjusted Charlson Comorbidity Index&#44; n &#40;&#37;&#41;</span></td><td class="td" title="table-entry  " align="char" valign="top">0&#46;608&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#8211;1 point&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;16&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76 &#40;13&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#8211;3 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;35&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">237 &#40;40&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>4&#8211;5 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">178 &#40;30&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;6 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91 &#40;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Origin &#40;emergency department&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;23&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41 &#40;7&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Type of admission &#40;medical&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;42&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102 &#40;17&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Malignancy-unrelated admission</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;33&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Transfusion of blood products&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;29&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">148 &#40;25&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;391&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sepsis&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Adverse event to chemotherapy&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;10&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;4&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;009</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">APACHE II score&#44; points &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;0 &#40;10&#46;4&#8211;16&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;0 &#40;10&#46;0&#8211;13&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">APACHE II score&#44; n &#40;&#37;&#41;</span></td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;10 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;14&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">125 &#40;21&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>10&#8211;14 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;48&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">357 &#40;61&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>15&#8211;19 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;23&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88 &#40;15&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;20 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;12&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Gender&#44; male</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;93&#8211;2&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Primary tumour location</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Head and neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;&#8211;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Thorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;44&#8211;2&#46;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;892&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gastrointestinal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;31&#8211;1&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;532&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Gynaecological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&#8211;3&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;967&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33&#8211;3&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;912&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Haematological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;57&#8211;4&#46;99&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Brain<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;86&#8211;54&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">&#60;0&#46;0001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;30&#8211;4&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;806&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18&#8211;1&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;393&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Clinical stage of cancer</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ref&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#40;&#8211;&#41;&nbsp;\t\t\t\t\t\t\n
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Aygencel"
                            1 => "M&#46; Turkoglu"
                            2 => "G&#46; Turkoz"
                            3 => "M&#46; Benekli"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jcrc.2014.01.014"
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              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Retrospective analysis of outcome of women with breast or gynaecological cancer in the intensive care unit"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Ostermann"
                            1 => "M&#46; Raimundo"
                            2 => "A&#46; Williams"
                            3 => "C&#46; Whiteley"
                            4 => "R&#46; Beale"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
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              "identificador" => "bib0195"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes for patients with lung cancer admitted to intensive care units"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; M&#226;nica"
                            1 => "M&#46; Basso"
                            2 => "D&#46; Rossato"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
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              "identificador" => "bib0200"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiologies&#44; diagnostic strategies&#44; and outcomes of diffuse pulmonary infiltrates causing acute respiratory failure in cancer patients&#58; a retrospective observational study"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            2 => "B&#46;H&#46; Jeong"
                            3 => "S&#46; Yeon"
                            4 => "M&#46; Pyo"
                            5 => "O&#46; Jung"
                          ]
                        ]
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                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1186/cc12829"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2013"
                        "volumen" => "17"
                        "paginaInicial" => "R150"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23880212"
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                      "titulo" => "Outcome of lung cancer patients admitted to the intensive care unit with acute respiratory failure"
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                          "autores" => array:6 [
                            0 => "S&#46; Anisoglou"
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                            3 => "S&#46; Kakolyris"
                            4 => "G&#46; Anastasiadou"
                            5 => "I&#46; Pnevmatikos"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hippokratia"
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                        "paginaInicial" => "60"
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                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23935346"
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                      "titulo" => "Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency"
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                          "autores" => array:6 [
                            0 => "X&#46; Xing"
                            1 => "Y&#46; Gao"
                            2 => "H&#46;J&#46; Wang"
                            3 => "Q&#46;H&#46; Yang"
                            4 => "C&#46;L&#46; Huang"
                            5 => "S&#46;N&#46; Qu"
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                        ]
                      ]
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                  ]
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                    0 => array:2 [
                      "doi" => "10.5847/wjem.j.1920-8642.2013.01.008"
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                        "tituloSerie" => "World J Emerg Med"
                        "fecha" => "2013"
                        "volumen" => "4"
                        "paginaInicial" => "43"
                        "paginaFinal" => "47"
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                    0 => array:2 [
                      "titulo" => "Which adverse events are associated with mortality and prolonged length of stay following colorectal surgery&#63;"
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                            3 => "J&#46;F&#46; Hall"
                            4 => "P&#46;W&#46; Marcello"
                            5 => "D&#46;J&#46; Schoetz"
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                    0 => array:2 [
                      "doi" => "10.1007/s11605-013-2224-3"
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                        "tituloSerie" => "J Gastrointest Surg"
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                        "paginaInicial" => "1485"
                        "paginaFinal" => "1493"
                        "link" => array:1 [
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Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2017.08.013

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	11	6	17
2024 October	49	40	89
2024 September	58	31	89
2024 August	65	44	109
2024 July	38	25	63
2024 June	41	38	79
2024 May	31	23	54
2024 April	43	42	85
2024 March	47	31	78
2024 February	37	33	70
2024 January	30	30	60
2023 December	25	32	57
2023 November	32	33	65
2023 October	24	34	58
2023 September	26	35	61
2023 August	26	17	43
2023 July	32	32	64
2023 June	20	19	39
2023 May	43	42	85
2023 April	36	23	59
2023 March	50	35	85
2023 February	49	33	82
2023 January	35	16	51
2022 December	65	48	113
2022 November	47	38	85
2022 October	68	51	119
2022 September	32	46	78
2022 August	36	40	76
2022 July	36	50	86
2022 June	34	28	62
2022 May	43	35	78
2022 April	39	53	92
2022 March	45	59	104
2022 February	43	26	69
2022 January	63	33	96
2021 December	42	51	93
2021 November	58	44	102
2021 October	70	66	136
2021 September	56	33	89
2021 August	53	39	92
2021 July	34	32	66
2021 June	33	34	67
2021 May	56	48	104
2021 April	119	80	199
2021 March	96	26	122
2021 February	95	33	128
2021 January	98	31	129
2020 December	78	20	98
2020 November	67	38	105
2020 October	64	25	89
2020 September	56	20	76
2020 August	26	28	54
2020 July	29	33	62
2020 June	54	14	68
2020 May	49	11	60
2020 April	67	18	85
2020 March	54	21	75
2020 February	84	37	121
2020 January	20	26	46
2019 December	29	23	52
2019 November	28	24	52
2019 October	20	17	37
2019 September	24	16	40
2019 August	22	15	37
2019 July	24	23	47
2019 June	11	11	22
2019 May	34	33	67
2019 April	13	17	30
2019 March	25	20	45
2019 February	16	22	38
2019 January	25	44	69
2018 December	49	25	74
2018 November	3	6	9
2018 August	1	0	1
2018 July	0	1	1

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