François Vincent1, Marcio Soares2,3, Djamel Mokart4, Virginie Lemiale5, Fabrice Bruneel6, Marouane Boubaya7, Frédéric Gonzalez8, Yves Cohen8, Elie Azoulay5,9, Michaël Darmon5. 1. Medical-Surgical Intensive Care Unit, Le Raincy-Montfermeil General Hospital, 10, rue du Général Leclerc, 93370, Montfermeil, France. frncsvncnt@aol.com. 2. D'Or Institute for Research and Education, Rio de Janeiro, Brazil. 3. Programa de Pós-Graduação em Oncologia, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. 4. Anesthesiology and Intensive Care Unit, Paoli Calmette Institute, Marseille, France. 5. Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France. 6. Medical-Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France. 7. Clinical Research Unit, Avicenne University Hospital, AP-HP, Bobigny, France. 8. Medical-Surgical Intensive Care Unit, Avicenne University Hospital, AP-HP, Bobigny, France. 9. ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS), INSERM, Paris Diderot Sorbonne University, Paris, France.
Abstract
OBJECTIVES: To assess outcomes at hospital discharge and day-120 after intensive care unit (ICU) discharge among patients with solid cancer admitted to ICU and to identify characteristics associated with in-hospital and day-120 after ICU discharge mortalities. DESIGN: International, multicenter, retrospective study. SETTING: Five ICUs in France and Brazil, two located in cancer centers, two in university affiliated and one in general hospitals. PATIENTS: Consecutive patients aged > 18 years, with underlying solid cancers (known before admission to the ICU or diagnosed during the stay in the ICU), admitted to the participating ICUs and discharged alive from the ICU from January 2006 to December 2011 were included in this study. Patients admitted after scheduled surgery or to secure procedure were excluded. Variables of interest were in-hospital and day-120 post-ICU mortality among patients discharged alive from the ICU. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: A total of 1053 patients aged 63 years (54-71) (median [IQR]) were included. Most of the patients were of the male gender (66.8%). The in-ICU, in-hospital, and four-month post-ICU discharge mortalities were, respectively, 41.3, 60.7, and 65.8%. Among patients discharged alive from the ICU, in multivariate analysis, factors associated with four months post-ICU discharge mortality were type of cancer (OR from 0.25 to 0.52 when compared to lung cancers), systemic extension of the disease (OR 2.54; 95% CI 1.87-3.45), need for invasive mechanical ventilation (OR 2.54; 95% CI 1.80-3.59), for vasopressors (OR 2.35; 95% CI 1.66-3.29), or renal replacement therapy (OR 1.54; 95% CI 0.99-2.38). A predictive score, "Oncoscore," was built performing fairly in predicting 4 months post-ICU discharge outcome (AUC 0.74; 95% CI 0.71-0.77). CONCLUSION: Despite the high day-120 mortality following the ICU discharge, our study reports a meaningful medium-term survival rate after the ICU discharge of solid cancer patients. Of utmost importance, the "Oncoscore" must be validated in prospective studies and cannot be used, in its form without external validation, for individual decision making. Prospective studies to answer questions not provided by this study are needed, including only patients with solid cancers admitted in the ICU for medical reasons or after emergency surgery.
OBJECTIVES: To assess outcomes at hospital discharge and day-120 after intensive care unit (ICU) discharge among patients with solid cancer admitted to ICU and to identify characteristics associated with in-hospital and day-120 after ICU discharge mortalities. DESIGN: International, multicenter, retrospective study. SETTING: Five ICUs in France and Brazil, two located in cancer centers, two in university affiliated and one in general hospitals. PATIENTS: Consecutive patients aged > 18 years, with underlying solid cancers (known before admission to the ICU or diagnosed during the stay in the ICU), admitted to the participating ICUs and discharged alive from the ICU from January 2006 to December 2011 were included in this study. Patients admitted after scheduled surgery or to secure procedure were excluded. Variables of interest were in-hospital and day-120 post-ICU mortality among patients discharged alive from the ICU. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: A total of 1053 patients aged 63 years (54-71) (median [IQR]) were included. Most of the patients were of the male gender (66.8%). The in-ICU, in-hospital, and four-month post-ICU discharge mortalities were, respectively, 41.3, 60.7, and 65.8%. Among patients discharged alive from the ICU, in multivariate analysis, factors associated with four months post-ICU discharge mortality were type of cancer (OR from 0.25 to 0.52 when compared to lung cancers), systemic extension of the disease (OR 2.54; 95% CI 1.87-3.45), need for invasive mechanical ventilation (OR 2.54; 95% CI 1.80-3.59), for vasopressors (OR 2.35; 95% CI 1.66-3.29), or renal replacement therapy (OR 1.54; 95% CI 0.99-2.38). A predictive score, "Oncoscore," was built performing fairly in predicting 4 months post-ICU discharge outcome (AUC 0.74; 95% CI 0.71-0.77). CONCLUSION: Despite the high day-120 mortality following the ICU discharge, our study reports a meaningful medium-term survival rate after the ICU discharge of solid cancerpatients. Of utmost importance, the "Oncoscore" must be validated in prospective studies and cannot be used, in its form without external validation, for individual decision making. Prospective studies to answer questions not provided by this study are needed, including only patients with solid cancers admitted in the ICU for medical reasons or after emergency surgery.
Authors: Suhail S Siddiqui; Amit M Narkhede; Harish K Chaudhari; Natesh Prabu Ravisankar; Ujwal Dhundi; Satish Sarode; Jigeeshu V Divatia; Atul P Kulkarni Journal: Indian J Crit Care Med Date: 2021-12
Authors: Cristina Gutierrez; Anne Rain T Brown; Heather P May; Amer Beitinjaneh; R Scott Stephens; Prabalini Rajendram; Joseph L Nates; Stephen M Pastores; Ananda Dharshan; Alice Gallo de Moraes; Matthew K Hensley; Lei Feng; Jennifer N Brudno; Janhavi Athale; Monalisa Ghosh; James N Kochenderfer; Alejandro S Arias; Yi Lin; Colleen McEvoy; Elena Mead; Jason Westin; Natalie Kostelecky; Agrima Mian; Megan M Herr Journal: Crit Care Med Date: 2022-01-01 Impact factor: 7.598
Authors: C Barth; M Soares; A C Toffart; J F Timsit; G Burghi; C Irrazabal; N Pattison; E Tobar; B F Almeida; U V Silva; L C Azevedo; A Rabbat; C Lamer; A Parrot; V C Souza-Dantas; F Wallet; F Blot; G Bourdin; C Piras; J Delemazure; M Durand; J Salluh; E Azoulay; Virginie Lemiale Journal: Ann Intensive Care Date: 2018-08-04 Impact factor: 6.925