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Characteristics and outcomes of patients with cancer requiring admission to intensive care units: A prospective multicenter study*

Soares, Márcio MD, PhD; Caruso, Pedro MD, PhD; Silva, Eliézer MD, PhD; Teles, José M. M. MD; Lobo, Suzana M. A. MD, PhD; Friedman, Gilberto MD, PhD; Dal Pizzol, Felipe MD, PhD; Mello, Patricia V. C. MD; Bozza, Fernando A. MD, PhD; Silva, Ulisses V. A. MD; Torelly, André P. MD; Knibel, Marcos F. MD; Rezende, Ederlon MD; Netto, José J. MD; Piras, Claudio MD; Castro, Aline RN; Ferreira, Bruno S. MD; Réa-Neto, Álvaro MD, PhD; Olmedo, Patrícia B. BASLP; Salluh, Jorge I. F. MD, MSc

doi: 10.1097/CCM.0b013e3181c0349e
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Objective: To evaluate the characteristics and outcomes of patients with cancer admitted to several intensive care units. Knowledge on patients with cancer requiring intensive care is mostly restricted to single-center studies.

Design: Prospective, multicenter, cohort study.

Setting: Intensive care units from 28 hospitals in Brazil.

Patients: A total of 717 consecutive patients included over a 2-mo period.

Interventions: None.

Measurements and Main Results: There were 667 (93%) patients with solid tumors and 50 (7%) patients had hematologic malignancies. The main reasons for intensive care unit admission were postoperative care (57%), sepsis (15%), and respiratory failure (10%). Overall hospital mortality rate was 30% and was higher in patients admitted because of medical complications (58%) than in emergency (37%) and scheduled (11%) surgical patients (p < .001). Adjusting for covariates other than the type of admission, the number of hospital days before intensive care unit admission (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01–1.37), higher Sequential Organ Failure Assessment scores (OR, 1.25; 95% CI, 1.17–1.34), poor performance status (OR, 3.40; 95% CI, 2.19 –5.26), the need for mechanical ventilation (OR, 2.42; 95% CI, 1.51–3.87), and active underlying malignancy in recurrence or progression (OR, 2.42; 95% CI, 1.51–3.87) were associated with increased hospital mortality in multivariate analysis.

Conclusions: This large multicenter study reports encouraging survival rates for patients with cancer requiring intensive care. In these patients, mortality was mostly dependent on the severity of organ failures, performance status, and need for mechanical ventilation rather than cancer-related characteristics, such as the type of malignancy or the presence of neutropenia.

From the ICU (MS, PBO, JIFS), Hospital de Câncer - I, Instituto Nacional de Câncer, Rio de Janeiro, Brazil; ICU (PC), Hospital A. C. Camargo, São Paulo, Brazil; ICU (ES), Hospital Israelita Albert Einstein, São Paulo, Brazil; ICU (JMMT), Hospital Português, Salvador, Brazil; Division of Critical Care Medicine (SMAL), Department of Internal Medicine, Medical School and Hospital de Base, São José do Rio Preto, Brazil; ICU (GF), Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; ICU (GF, APT), Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil; Laboratório de Fisiopatologia Experimental (FDP), Programa de Pós-Graduação Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense, Criciúma, Brazil; ICU (PVCM), Universidade Estadual do Piauí, Teresina, Brazil; ICU (FAB), Instituto de Pesquisas Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; ICU (UVAS), Hospital do Câncer de Barretos - Fundação Pio XII, Barretos, Brazil; Hospital São Lucas (MFK), Rio de Janeiro, Brazil; ICU (ER), Hospital do Servidor Público Estadual, São Paulo, Brazil; ICU (JJN), Instituto Nacional de Câncer - Hospital do Câncer II, Rio de Janeiro, Brazil; ICU (CP), Vitória Apart Hospital, Vitória, Brazil; ICU (AC), Hospital Samaritano, Rio de Janeiro, Brazil; Hospital Pasteur (BSF), Rio de Janeiro, Brazil; and ICU (AR-N), Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal's Web site (www.ccmjournal.org).

This study was supported, in part, by Instituto Nacional de Câncer.

Dr. Soares and Dr. Bozza are supported, in part, by individual research grants from CNPq. The remaining authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: marciosoaresms@yahoo.com.br

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins