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AlSaied G, Lababidi H, AlHawdar T, AlZahrani S, AlMotairi A, AlMaani M. Outcome of Cancer Patients with an Unplanned Intensive Care Unit Admission: Predictors of Mortality and Long-term Survival. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2024; 12:153-161. [PMID: 38764561 PMCID: PMC11098267 DOI: 10.4103/sjmms.sjmms_145_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/27/2023] [Accepted: 11/19/2023] [Indexed: 05/21/2024]
Abstract
Background Understanding the characteristics and outcomes of cancer patients with unplanned ICU admission is imperative for therapeutic decisions and prognostication purposes. Objective To describe the clinical characteristics of patients with hematological and non-hematological malignancies (NHM) who require unplanned ICU admission and to determine the predictors of mortality and long-term survival. Methods This retrospective study included all patients with cancer who had an unplanned ICU admission between 2011 and 2016 at a tertiary hospital in Saudi Arabia. The following variables were collected: age, gender, ICU length of stay (LOS), APACHE II score, type of malignancy, febrile neutropenia, source and time of admission, and need for mechanical ventilation (MV), renal replacement therapy (RRT), and treatment with vasopressors (VP). Predictors of mortality and survival rates at 28 days and 3, 6, and 12 months were calculated. Results The study included 410 cancer patients with 466 unplanned ICU admissions. Of these, 52% had NHM. The average LOS in the ICU was 9.6 days and the mean APACHE score was 21.9. MV was needed in 73% of the patients, RRT in 15%, and VP in 24%, while febrile neutropenia was present in 24%. There were statistically significant differences between survivors and non-survivors in the APACHE II score (17.7 ± 8.0 vs. 25.6 ± 9.2), MV use (52% vs. 92%), need for RRT (6% vs. 23%), VP use (42% vs. 85%), and presence of febrile neutropenia (18% vs. 30%). The predictors of mortality were need for MV (OR = 4.97), VP (OR = 3.43), RRT (OR = 3.31), and APACHE II score (OR = 1.10). Survival rates at 28 days, 3, 6, and 12 months were 52%, 28%, 22%, and 15%, respectively. Conclusion The survival rate of cancer patients with an unplanned admission to the ICU remains low. Predictors of mortality include need for MV, RRT, and VP and presence of febrile neutropenia. About 85% of cancer patients died within 1 year after ICU admission.
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Affiliation(s)
- Ghiath AlSaied
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
| | - Hani Lababidi
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
- Department of Health Professions Education, MGH-Institute of Health Professions, Boston, MA, USA
| | - Taher AlHawdar
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
| | - Saud AlZahrani
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
| | - Abdullah AlMotairi
- Department of Critical Care, Suleiman AlHabib Hospital, Riyadh, Saudi Arabia
| | - Mohamad AlMaani
- Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA
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Rourke S, Paterson C. How Does Health-Related Quality of Life Change Over Time in Cancer Survivors Following an Admission to the Intensive Care Unit?: An Integrative Review. Cancer Nurs 2024; 47:100-111. [PMID: 36066345 DOI: 10.1097/ncc.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer survivors account for 15% to 20% of all intensive care unit (ICU) admissions. In general ICU populations, patients are known to experience reduced health-related quality of life (HRQoL). However, little is known about HRQoL impacts among cancer survivors following a critical illness in ICU. OBJECTIVE The aim of this study was to critically synthesize the evidence to further understand the impact of a critical illness and ICU admission in cancer survivors. METHODS An integrative review was conducted and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. Three electronic databases were searched (MEDLINE, CINAHL, and EMBASE) using keywords and Boolean logic. Quality appraisal, data extraction, and a narrative synthesis were completed for all included studies by 2 reviewers. RESULTS Eleven publications met inclusion criteria. Health-related quality-of-life domains most frequently reported in cancer survivors after discharge from ICU included the following: physical function limitations, physical symptoms, and anxiety/depression. CONCLUSIONS Health-related quality of life decreased immediately after the admission to ICU with a gradual increase in the 3 to 12 months following. Cancer survivors are vulnerable to physical limitations, pain, and social isolation after an admission to ICU. IMPLICATIONS FOR PRACTICE Cancer survivors who have been affected by a critical illness are at risk of reduced HRQoL after an admission to ICU. This integrative review will help clinicians and researchers to develop patient-centered models of care during the recovery of critical illness, which are currently lacking in service delivery.
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Affiliation(s)
- Shalyn Rourke
- Author Affiliations: Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group (Ms Rourke, Dr Paterson) and School of Nursing, Midwifery and Public Health (Ms Rourke, Dr Paterson), University of Canberra, Bruce; and Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, ACT Health Directorate Level 3, Canberra Hospital, Garran (Ms Rourke, Dr Paterson), Canberra, Australian Capital Territory, Australia; and Robert Gordon University, Aberdeen, Scotland, United Kingdom (Ms Rourke, Dr Paterson)
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Yuan ZN, Wang HJ, Gao Y, Qu SN, Huang CL, Wang H, Zhang H, Yang QH, Xing XZ. The effect of the underlying malignancy on short- and medium-term survival of critically ill patients admitted to the intensive care unit: a retrospective analysis based on propensity score matching. BMC Cancer 2021; 21:417. [PMID: 33858357 PMCID: PMC8051069 DOI: 10.1186/s12885-021-08152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background Advances in oncology led to a substantial increase in the number of patients requiring admission to the ICU. It is significant to confirm which cancer critical patients can benefit from the ICU care like noncancer patients. Methods An observational retrospective cohort study using intensive care unit (ICU) admissions of Medical Information Mart for Intensive Care III from the Beth Israel Deaconess Medical Center in Boston, MA, USA between 2001 and 2012 was conducted. Propensity score matching was used to reduce the imbalance between two matched cohorts. ICU patients with cancer were compared with those without cancer in terms of patients’ characteristics and survival. Results There were 38,508 adult patients admitted to ICUs during the period. The median age was 65 years (IQR, 52–77) and 8308 (21.6%) had an underlying malignancy diagnosis. The noncancer group had a significant survive advantage at the point of 28-day, 90-day, 365-day and 1095-day after ICU admission compared with cancer group (P < 0.001 for all) after PSM. Subgroup analysis showed that the diagnosis of malignancy didn’t decrease 28-day and 90-day survive when patients’ age ≥ 65-year, patients in surgical intensive care unit or cardiac surgery recovery unit or traumatic surgical intensive care unit, elective admissions, patients with renal replacement therapy or vasopressor support (P > 0.05 for all). Conclusions Malignancy is a common diagnosis among ICU patients. Patients without cancer have a survive advantage compared with patients with cancer in the short- and medium-term. However, in selected groups, cancer critical patients can benefit from the ICU care service like noncancer patients in the short-term.
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Affiliation(s)
- Zhen-Nan Yuan
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Hai-Jun Wang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Yong Gao
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Shi-Ning Qu
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Chu-Lin Huang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Hao Wang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Hao Zhang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Quan-Hui Yang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Xue-Zhong Xing
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
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Asdahl PH, Christensen S, Kjærsgaard A, Christiansen CF, Kamper P. One-year mortality among non-surgical patients with hematological malignancies admitted to the intensive care unit: a Danish nationwide population-based cohort study. Intensive Care Med 2020; 46:756-765. [PMID: 32072301 DOI: 10.1007/s00134-019-05918-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Contemporary data on mortality of hematological patients admitted to the intensive care unit (ICU) are missing. In a Danish nationwide set-up, we assessed 30-day and 1-year mortality in this population including impact of age and comorbidity, with non-hematological patients as reference. METHODS This population-based cohort study included all non-surgical patients > 15 years of age admitted to an ICU in Denmark between 2010 and 2015. Data on hematological malignancies were obtained from the Danish Hematological Database, and information on the Charlson Comorbidity Index was obtained from the Danish National Patient Registry. Thirty-day and 1-year mortality was estimated using the Kaplan-Meier method. We used Cox proportional hazards regression to estimate hazard ratios. RESULTS We included 2122 ICU patients with a hematological malignancy and 88,951 non-hematological ICU patients. The 30-day mortality was 44% (95% confidence interval: 42-47%) among hematological patients and 27% (27-27%) among non-hematological patients. Similarly, 1-year mortality was 66% (64-68%) and 37% (37-37%), respectively. The corresponding hazard ratio with adjustment for age, sex, and comorbidity was 1.62 (1.54-1.71). Excess mortality was observed in all subgroups of age or of comorbidity. For example, the 1-year mortality for patients with Charlson Comorbidity Index Score > 3: 70% (66-74%) among hematological patients and 62% (61-63%) among non-hematological patients. CONCLUSION ICU patients with hematological malignancy had higher mortality than other ICU patients. However, one third of critically ill patients with a hematological malignancy is alive 1 year after ICU admission.
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Affiliation(s)
- Peter H Asdahl
- Department of Hematology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus, Denmark.
| | - Steffen Christensen
- Intensive Care Unit, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus, Denmark
| | - Anders Kjærsgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Christian F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Peter Kamper
- Department of Hematology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus, Denmark
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Hsiue EHC, Lee PL, Chen YH, Wu TH, Cheng CF, Cheng KM, Yang PC, Chen HW, Lin PY, Chiang DL, Wu HD, Yang JCH, Yu CJ. Weaning outcome of solid cancer patients requiring mechanical ventilation in the intensive care unit. J Formos Med Assoc 2019; 118:995-1004. [PMID: 30857753 DOI: 10.1016/j.jfma.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/22/2019] [Accepted: 02/20/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Whether the weaning outcome of solid cancer patients receiving mechanical ventilation (MV) in the intensive care unit (ICU) is comparable to that in non-cancer patients is unknown. The aim of this study was to compare the weaning outcomes between non-cancer patients and patients with different types of cancer. METHODS We studied patients requiring MV during ICU stay for medical reasons between 2012 and 2014. Cancer patients were grouped into those with lung cancer (LC), head and neck cancer (HNC), hepatocellular carcinoma (HCC), and other cancers (OC). The primary endpoint was successful weaning at day 90 after the initiation of MV, and the main secondary endpoints were 28-day and 90-day mortality after ICU admission. RESULTS Five hundred and eighteen patients with solid cancers and 1362 non-cancer patients were recruited. The rate of successful weaning at day 90 was 57.9% in cancer patients, which was lower than 68.9% in non-cancer patients (p < 0.001). Compared to non-cancer patients, LC was associated with a lower probability of weaning at day 90 (hazard ratio 0.565, 95% CI 0.446 to 0.715), while HNC, HCC, and OC had similar probabilities. The 28-day and 90-day mortality rates were higher in cancer patients than in non-cancer patients (45.2% vs. 29.4%, and 65.6% vs. 37.7%, respectively, both p < 0.001). CONCLUSION Among mechanically ventilated patients in the ICU, those with LC were associated with a lower probability of weaning at day 90 compared to non-cancer patients.
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Affiliation(s)
- Emily Han-Chung Hsiue
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Cellular and Molecular Medicine Program, Johns Hopkins School of Medicine, Suite 2-103, 1830 East Monument St, Baltimore, MD, 21205, USA
| | - Pei-Lin Lee
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Center for Electronics Technology Integration, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
| | - Yung-Hsuan Chen
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Ting-Hui Wu
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Chiao-Feng Cheng
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Keng-Man Cheng
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Po-Chun Yang
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Hsing-Wu Chen
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Pei-Yu Lin
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Dai-Lung Chiang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, No.1, Sec.4, Roosevelt Road, Taipei, Taiwan
| | - Huey-Dong Wu
- Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Department of Medical Research, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, No. 1, Sec. 1, Ren-Ai Rd, 100, Taipei, Taiwan; National Taiwan University Cancer Center, No. 1, Sec. 1, Ren-Ai Rd, Taipei, 100, Taiwan
| | - Chong-Jen Yu
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan
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Analysis of causality from observational studies and its application in clinical research in Intensive Care Medicine. Med Intensiva 2018; 42:292-300. [PMID: 29501284 DOI: 10.1016/j.medin.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/07/2017] [Accepted: 01/13/2018] [Indexed: 11/22/2022]
Abstract
Random allocation of treatment or intervention is the key feature of clinical trials and divides patients into treatment groups that are approximately balanced for baseline, and therefore comparable covariates except for the variable treatment of the study. However, in observational studies, where treatment allocation is not random, patients in the treatment and control groups often differ in covariates that are related to intervention variables. These imbalances in covariates can lead to biased estimates of the treatment effect. However, randomized clinical trials are sometimes not feasible for ethical, logistical, economic or other reasons. To resolve these situations, interest in the field of clinical research has grown in designing studies that are most similar to randomized experiments using observational (i.e. non-random) data. Observational studies using propensity score analysis methods have been increasing in the scientific papers of Intensive Care. Propensity score analyses attempt to control for confounding in non-experimental studies by adjusting for the likelihood that a given patient is exposed. However, studies with propensity indexes may be confusing, and intensivists are not familiar with this methodology and may not fully understand the importance of this technique. The objectives of this review are: to describe the fundamentals of propensity index methods; to present the techniques to adequately evaluate propensity index models; to discuss the advantages and disadvantages of these techniques.
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