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Available online 19 March 2025
Short- and long-term mortality in critically ill patients with solid cancer. The Vall d’Hebron Intensive Care Unit-Vall d’Hebron Institute of Oncology Cohort: a retrospective study
Mortalidad a corto y largo plazo en pacientes críticos con tumores de órgano sólido. Cohorte Unidad de Cuidados Intensivos Vall d’Hebron e Instituto de Oncología Vall d’Hebron: estudio retrospectivo
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Cándido Díaz-Lagaresa,
Corresponding author
candido.diaz@vallhebron.cat

Corresponding author.
, Alejandra García-Rochea, Andrés Pachecoa, Javier Rosb, Erika P. Plata-Menchacaa, Adaia Albasanzc, David Péreza, Nadia Saoudib, Isabel Ruiz-Campsc, Elena Élezb, Ricard Ferrera
a Intensive Care Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, SODIR Research Group, Vall d’Hebron Institut de Recerca (VHIR), Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain
b Oncology Department, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, C/Natzaret, 115-117, 08035, Barcelona, Spain
c Infectious Diseases Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain
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Received 14 October 2024. Accepted 19 February 2025
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Table 1. Baseline characteristics and during ICU course; differences between in-hospital survivors and non-survivors.
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Table 2. Cox proportional-hazards regression model of variables associated with in-hospital mortality.
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Table 3. Differences between one-year survivors and non-survivors in patients discharged alive from the hospital.
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Table 4. Cox proportional-hazards regression model of variables associated with one-year mortality in hospital survivors.
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Abstract
Objective

To describe in-hospital and one-year mortality and to identify prognostic variables associated with mortality.

Design

Retrospective cohort study.

Setting

Tertiary referral hospital in Barcelona (Spain).

Patients

Consecutive patients with solid cancer and unplanned admission to the ICU over a ten year period (2010–2019).

Main variables of interest

In-hospital mortality, one-year mortality, type of cancer, metastatic disease, ECOG, APACHE, SOFA, invasive mechanical ventilation, vasoactive drugs, renal replacement therapy.

Results

Three hundred and ninety-five patients were admitted to the ICU; 193 (48.8%) had metastatic disease, and 22 (5.9%) presented neutropenia. The median SOFA score on day 1 of ICU admission was 6 (3−9). ICU, in-hospital, and one-year mortality were 27.9% (110 patients), 39% (139 patients), and 61.1% (236 patients), respectively. A non-surgical admission, a higher ECOG, a SOFA score > 9 on day 1, a non-decreasing SOFA score on day 5, and requiring invasive mechanical ventilation were factors associated with in-hospital mortality. ECOG, inability to resume anticancer therapy, and ICU admission due to respiratory failure were associated with one-year mortality in hospital survivors.

Conclusion

Survival in critically ill solid cancer patients is substantial, even when metastatic disease exists. Short-term outcomes were associated with ECOG and organ dysfunction, not cancer per se. The prognosis of patients with a non-decreasing SOFA score on day 5 is poor, especially when the SOFA score on day 1 was >9. Long-term mortality was associated with functional status and inability to resume anticancer therapy.

Keywords:
Cancer
Critical illness
Multiple organ failure
Febrile neutropenia
Respiratory insufficiency
Medical futility
Resumen
Objetivo

Describir la mortalidad hospitalaria y al año e identificar factores pronósticos asociados a la misma.

Diseño

Estudio de cohortes retrospectivo

Ámbito

Hospital terciario de referencia en Barcelona (España)

Patientes

Pacientes consecutivos con neoplasia de organo sólido con ingreso no programado en UCI durante 10 años (2010–2019).

Variables de interés principales

Mortalidad hospitalaria, mortalidad al año, cáncer, metástasis, ECOG, APACHE, SOFA, ventilación mecánica, drogas vasoactivas, terapias de reemplazo renal.

Resultados

Trescientos noventa y cinco pacientes ingresaron en la UCI; 193 (48.8%) tenían enfermedad metastásica y 22 (5.9%) neutropenia. El SOFA el dia 1 fue 6 (3-9). La mortalidad en UCI, hospitalaria y al año fue del 27.9% (110 pacientes), 39% (139 pacientes) y 61.1% (236 pacientes), respectivamente. Un ingreso no quirúrgico, un mayor ECOG, un SOFA > 9 el día 1, el no descenso del SOFA en el día 5 y la ventilación mecánica se asociaron con la mortalidad hospitalaria. El ECOG, no continuar el tratamiento anticanceroso y el ingreso por insuficiencia respiratoria se asociaron con la mortalidad al año.

Conclusión

La supervivencia en los pacientes críticos con cancer es significativa, incluso en presencia de enfermedad metastásica. La mortalidad a corto plazo se asocia al ECOG y la disfunción orgánica, y no al cáncer per se. El pronóstico de los pacientes en los que el SOFA no disminuye el día 5, especialmente si el SOFA inicial era >9, es sombrío. La mortalidad a largo plazo está condicionada por el estado funcional y la continuidad del tratamiento antineoplásico.

Palabras clave:
Cáncer
Enfermedad crítica
Fallo multiorgánico
Neutropenia febril
Insuficiencia respiratoria
Futilidad
Graphical abstract

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