Delphine Lebon1, Lucie Biard2, Sophie Buyse1, David Schnell1, Etienne Lengliné3, Camille Roussel1, Jean-Marc Gornet4, Nicolas Munoz-Bongrand5, Laurent Quéro6, Matthieu Resche-Rigon7, Elie Azoulay8, Emmanuel Canet9. 1. Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France. 2. Biostatistics Department, Saint-Louis University Hospital, AP-HP, Paris, France. 3. Adult Hematology Department, Saint-Louis University Hospital, AP-HP, Paris, France. 4. Department of Gastroenterology, Saint-Louis University Hospital, AP-HP, Paris, France. 5. Department of Digestive and Endocrine Surgery, Saint-Louis University Hospital, AP-HP, Paris, France. 6. Radiation-Oncology Department, Saint-Louis University Hospital, AP-HP, Paris, France. 7. Biostatistics Department, Saint-Louis University Hospital, AP-HP, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France. 8. Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France. 9. Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France. Electronic address: emmanuel.canet@aphp.fr.
Abstract
PURPOSE: To describe gastrointestinal emergencies in cancer patients. METHODS: All cancer patients admitted to the medical ICU of Saint-Louis Hospital for an acute abdominal syndrome during the study period (1997-2011) were included. RESULTS: A total of 164 patients were included. The most common diagnoses were: neutropenic enterocolitis (NE) (n=54, 33%), infectious colitis and peritonitis (n=51, 31%), bowel infiltration by malignancy (n=14, 9%), and mucosal toxicity of chemotherapy (n=12, 7%). Microbiologically documented infections were reported in 82 patients (50%), including 12 fungal infections. Twenty-seven patients (16%) underwent urgent surgery. The hospital mortality rate was 35%. Five factors were independently associated with hospital mortality: the Simplified Acute Physiology Score II (SAPS II) score on day 1 (OR 1.03/SAPS II point, 95% CI 1.01 to 1.05), microbiological documentation (OR 0.27, 95% CI 0.11 to 0.64), neutropenia (OR 0.42, 95% CI 0.19 to 0.95), allogenic hematopoietic stem-cell transplantation (HSCT) (OR 5.13, 95% CI 1.71 to 15.4), and mechanical ventilation (OR 3.42, 95% CI 1.37 to 8.51). CONCLUSIONS: Gastrointestinal emergencies in cancer patients are associated with significant mortality. Mortality correlated both with the severity of organ failure upon ICU admission and the underlying diagnosis. Interestingly, patients admitted to the ICU with neutropenia had better survival.
PURPOSE: To describe gastrointestinal emergencies in cancerpatients. METHODS: All cancerpatients admitted to the medical ICU of Saint-Louis Hospital for an acute abdominal syndrome during the study period (1997-2011) were included. RESULTS: A total of 164 patients were included. The most common diagnoses were: neutropenic enterocolitis (NE) (n=54, 33%), infectious colitis and peritonitis (n=51, 31%), bowel infiltration by malignancy (n=14, 9%), and mucosal toxicity of chemotherapy (n=12, 7%). Microbiologically documented infections were reported in 82 patients (50%), including 12 fungal infections. Twenty-seven patients (16%) underwent urgent surgery. The hospital mortality rate was 35%. Five factors were independently associated with hospital mortality: the Simplified Acute Physiology Score II (SAPS II) score on day 1 (OR 1.03/SAPS II point, 95% CI 1.01 to 1.05), microbiological documentation (OR 0.27, 95% CI 0.11 to 0.64), neutropenia (OR 0.42, 95% CI 0.19 to 0.95), allogenic hematopoietic stem-cell transplantation (HSCT) (OR 5.13, 95% CI 1.71 to 15.4), and mechanical ventilation (OR 3.42, 95% CI 1.37 to 8.51). CONCLUSIONS:Gastrointestinal emergencies in cancerpatients are associated with significant mortality. Mortality correlated both with the severity of organ failure upon ICU admission and the underlying diagnosis. Interestingly, patients admitted to the ICU with neutropenia had better survival.
Authors: Sara Cherri; Tiziana Prochilo; Luigina Rota; Stefano Mutti; Marco Garatti; Barbara Liserre; Alberto Zaniboni Journal: Case Rep Oncol Date: 2020-04-22