Márcio Soares1, Suzana Margarete Ajeje Lobo2, André Peretti Torelly3, Patricia Veiga de Carvalho Mello4, Ulisses Silva5, José Mário Meira Teles6, Eliézer Silva7, Pedro Caruso8, Gilberto Friedman3, Paulo César Pereira de Souza9, Alvaro Réa-Neto7, Arthur Oswaldo Vianna8, José Raimundo Azevedo10, Erico Vale11, Leila Rezegue12, Michele Godoy13, Marcelo Oliveira Maia14, Jorge Ibrain Figueira Salluh1. 1. Unidade de Terapia Intensiva, Hospital de Câncer-I, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil. 2. Divisão de Medicina Intensiva, Departamento de Clínica Médica, Faculdade de Medicina, Hospital de Base, São José do Rio Preto, SP, Brasil. 3. Unidade de Terapia Intensiva, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brasil. 4. Unidade de Terapia Intensiva, Universidade Estadual do Piauí, Teresina, PI, Brasil. 5. Unidade de Terapia Intensiva, Hospital do Câncer de Barretos, Fundação Pio XII, Barretos, SP, Brasil. 6. Unidade de Terapia Intensiva, Hospital Português, Salvador, BA, Brasil. 7. Unidade de Terapia Intensiva, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil. 8. Unidade de Terapia Intensiva, Hospital A. C. Camargo, São Paulo, SP, Brasil. 9. Unidade de Terapia Intensiva, Hospital de Clínicas Niterói, Niterói, RJ, Brasil. 10. Unidade de Terapia Intensiva, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil. 11. Unidade de Terapia Intensiva, Hospital Unimed Natal, Natal, RN, Brasil. 12. Unidade de Terapia Intensiva, Hospital Porto Dias, Belém, PA, Brasil. 13. Unidade de Terapia Intensiva, Hospital das Clínicas, Universidade Federal de Pernambuco, Pernambuco, PE, Brasil. 14. Unidade de Terapia Intensiva, Hospital Santa Luzia, Brasília, DF, Brasil.
Abstract
OBJECTIVES: Critically ill cancer patients are at increased risk for acute kidney injury, but studies on these patients are scarce and were all single centered conducted in specialized intensive care units. The objective was to evaluate the characteristics and outcomes in a prospective cohort of cancer patients admitted to several intensive care units with acute kidney injury. METHODS: Prospective multicenter cohort study conducted in intensive care units from 28 hospitals in Brazil over a two-month period. Univariate and multivariate logistic regression were used to identify factors associated with hospital mortality. RESULTS: Out of all 717 intensive care unit admissions, 87 (12%) had acute kidney injury and 36% of them received renal replacement therapy. Kidney injury developed more frequently in patients with hematological malignancies than in patients with solid tumors (26% vs. 11%, P=0.003). Ischemia/shock (76%) and sepsis (67%) were the main contributing factor for and kidney injury was multifactorial in 79% of the patients. Hospital mortality was 71%. General and renal-specific severity-of-illness scores were inaccurate in predicting outcomes for these patients. In a multivariate analysis, length of hospital stay prior to intensive care unit, acute organ dysfunctions, need for mechanical ventilation and a poor performance status were associated with increased mortality. Moreover, cancer-related characteristics were not associated with outcomes. CONCLUSIONS: The present study demonstrates that intensive care units admission and advanced life-support should be considered in selected critically ill cancer patients with kidney injury.
OBJECTIVES:Critically ill cancerpatients are at increased risk for acute kidney injury, but studies on these patients are scarce and were all single centered conducted in specialized intensive care units. The objective was to evaluate the characteristics and outcomes in a prospective cohort of cancerpatients admitted to several intensive care units with acute kidney injury. METHODS: Prospective multicenter cohort study conducted in intensive care units from 28 hospitals in Brazil over a two-month period. Univariate and multivariate logistic regression were used to identify factors associated with hospital mortality. RESULTS: Out of all 717 intensive care unit admissions, 87 (12%) had acute kidney injury and 36% of them received renal replacement therapy. Kidney injury developed more frequently in patients with hematological malignancies than in patients with solid tumors (26% vs. 11%, P=0.003). Ischemia/shock (76%) and sepsis (67%) were the main contributing factor for and kidney injury was multifactorial in 79% of the patients. Hospital mortality was 71%. General and renal-specific severity-of-illness scores were inaccurate in predicting outcomes for these patients. In a multivariate analysis, length of hospital stay prior to intensive care unit, acute organ dysfunctions, need for mechanical ventilation and a poor performance status were associated with increased mortality. Moreover, cancer-related characteristics were not associated with outcomes. CONCLUSIONS: The present study demonstrates that intensive care units admission and advanced life-support should be considered in selected critically ill cancerpatients with kidney injury.