Skip Navigation
Skip to contents

ACC : Acute and Critical Care

OPEN ACCESS
SEARCH
Search

Articles

Page Path
HOME > Acute Crit Care > Volume 33(3); 2018 > Article
Original Article Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units
Soo Jin Na1,*, Tae Sun Ha2,*, Younsuck Koh3, Gee Young Suh1,4, Shin Ok Koh5, Chae-Man Lim3, Won-Il Choi6, Young-Joo Lee7, Seok Chan Kim8, Gyu Rak Chon9, Je Hyeong Kim10, Jae Yeol Kim11, Jaemin Lim12, Sunghoon Park13, Ho Cheol Kim14, Jin Hwa Lee15, Ji Hyun Lee16, Jisook Park17, Juhee Cho18, Kyeongman Jeon1,4orcid, ,
Acute and Critical Care 2018;33(3):121-129.
DOI: https://doi.org/10.4266/acc.2018.00143
Published online: August 31, 2018

1Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

2Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

3Division of Pulmonary and Critical Care Medicine, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

4Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

5Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea

6Division of Pulmonary and Critical Care Medicine, Department of Medicine, Dongsan Hospital, Keimyung University, Daegu, Korea

7Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea

8Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea

9Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea

10Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan, Korea

11Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chung-Ang University College of Medicine, Seoul, Korea

12Division of Pulmonary and Critical Care Medicine, Department of Medicine, Gangneung Asan Hospital, University of Ulsan Medical College of Medicine, Gangneung, Korea

13Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea

14Division of Pulmonary and Critical Care Medicine, Department of Medicine, College of Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea

15Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, Korea

16Division of Pulmonary and Critical Care Medicine, Department of Medicine, CHA Bundang Hospital, CHA University, Seongnam, Korea

17Department of Multimedia, Seoul Women’s University, Seoul, Korea

18Samsung Advanced Institute of Health Science and Technology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding author Kyeongman Jeon Department of Critical Care Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwonro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-3429 Fax: +82-2-3410-6956 E-mail: kjeon@skku.edu
*The first two authors contributed equally to this study.
• Received: April 20, 2018   • Revised: July 16, 2018   • Accepted: July 17, 2018

Copyright © 2018 The Korean Society of Critical Care Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 8,676 Views
  • 276 Download
  • 10 Web of Science
  • 9 Crossref
  • 11 Scopus
prev next
  • Background
    The objective of this study was to investigate the characteristics and clinical outcomes of critically ill cancer patients admitted to intensive care units (ICUs) in Korea.
  • Methods
    This was a retrospective cohort study that analyzed prospective collected data from the Validation of Simplified Acute Physiology Score 3 (SAPS3) in Korean ICU (VSKI) study, which is a nationwide, multicenter, and prospective study that considered 5,063 patients from 22 ICUs in Korea over a period of 7 months. Among them, patients older than 18 years of age who were diagnosed with solid or hematologic malignancies prior to admission to the ICU were included in the present study.
  • Results
    During the study period, a total of 1,762 cancer patients were admitted to the ICUs and 833 of them were deemed eligible for analysis. Six hundred fifty-eight (79%) had solid tumors and 175 (21%) had hematologic malignancies, respectively. Respiratory problems (30.1%) was the most common reason leading to ICU admission. Patients with hematologic malignancies had higher Sequential Organ Failure Assessment (12 vs. 8, P<0.001) and SAPS3 (71 vs. 69, P<0.001) values and were more likely to be associated with chemotherapy, steroid therapy, and immunocompromised status versus patients with solid tumors. The use of inotropes/vasopressors, mechanical ventilation, and/or continuous renal replacement therapy was more frequently required in hematologic malignancy patients. Mortality rates in the ICU (41.7% vs. 24.6%, P<0.001) and hospital (53.1% vs. 38.6%, P=0.002) were higher in hematologic malignancy patients than in solid tumor patients.
  • Conclusions
    Cancer patients accounted for one-third of all patients admitted to the studied ICUs in Korea. Clinical characteristics were different according to the type of malignancy. Patients with hematologic malignancies had a worse prognosis than did patients with solid tumor.
The increase in the number of individuals with cancer and their improved prognosis has led to a growing demand for intensive care unit (ICU) management [1]. Even with these changes, some physicians consider ICU management in cancer patients to be a futile effort, and metastatic cancer is a common reason for refusal of ICU admission in practice [2]. Considering the disappointing survival rates of critically ill cancer patients in studies published in the 1980s and 1990s, triaging physicians’ refusal ICU admission to cancer patients seems reasonable [3,4].
However, recent investigations have demonstrated that advances in ICU management have led to an improvement of clinical outcomes in patients with and without cancer admitted to the ICU and suggested that critically ill cancer patients should not be excluded from the ICU only because they have cancer [5,6]. Domestic epidemiological data are needed to guide our practice in managing patients with cancer because there are geographic variations in the diagnosis of and type of cancer, but domestic data on clinical characteristics and outcomes in cancer patients are still limited [7]. Therefore, the present study was conducted to investigate the characteristics and clinical outcomes and predictors of mortality in critically ill cancer patients admitted to the ICU in Korea.
Study Design and Population
This study used data from the Validation of Simplified Acute Physiology Score 3 (SAPS3) in Korean ICU (VSKI) study. The VSKI study, which is a nationwide, multicenter, and prospective study, was conducted by the Korean Study Group on Respiratory Failure between July 1, 2010 and January 31, 2011 to evaluate the prognostic performance of the SAPS3 in a large prospective cohort in Korea [8]. It included patients from 22 ICUs (14 medical, six surgical, and two multidisciplinary) in 15 tertiary or university-affiliated hospitals. Only the data from the index ICU admission were included.
A total of 5,063 patients were admitted to participating ICUs during the study period. Patients who were older than 18 years of age and diagnosed with solid or hematologic malignancies prior to admission to the ICU were eligible for inclusion in the present study. Among them, we excluded patients if they were electively admitted for postoperative care, transferred from other participating ICUs, or if they had no data available regarding hospital mortality (Figure 1). Patients were followed up until the time of death or hospital discharge. This study was approved by the relevant Institutional Review Board(s) of each participating hospital, and the requirement for informed consent was waived because of the noninterventional nature of the study.
Data Collection and Clinical Outcomes
Patient data were collected using a web-based database. The definitions of variables used in the original SAPS3 model were used for this study [9]. We used the most abnormal set of data from the one hour prior to or after ICU admission to calculate SAPS3. The following data were sourced from the medical charts of the participants: demographic data; location prior to ICU admission; reason(s) for ICU admission; infection and surgical status at the time of ICU admission; laboratory data and physiologic measurements, which were collected within 1 hour before and 24 hours after ICU admission; and treatment(s) received during ICU stay. The severity of illness was assessed by the SAPS3 and Sequential Organ Failure Assessment (SOFA) score. The primary outcome in this study was hospital mortality. Secondary outcomes were ICU mortality, length of hospital stay, and length of ICU stay.
Definition
Cancer was categorized as solid or hematologic malignancy. Solid tumors were defined as cancer with proven distant (not regional lymph node) metastasis by surgery, computed tomography scan, or any other appropriate method. Hematologic malignancies were defined as tumors of the hematopoietic and lymphoid tissue including lymphoma, acute leukemia, and multiple myeloma. Infection was defined as the presence of a pathogenic microorganism in a sterile site and/or clinically suspected infection, plus the administration of antibiotics. Severe sepsis and septic shock were defined as sepsis associated with acute organ dysfunction and sepsis with acute circulatory failure characterized by persistent arterial hypotension (i.e., systolic arterial pressure <90 mmHg, mean arterial pressure <60 mmHg, or a reduction in systolic blood pressure >40 mmHg from baseline) despite adequate volume resuscitation, respectively [10]. Acute lung injury and acute respiratory distress syndrome were defined as arterial oxygen pressure to inspiratory oxygen fraction (PaO2/FiO2) ratio <300 and <200, respectively, with the following criteria: acute onset, bilateral infiltrates on chest radiography, and pulmonary artery wedge pressure <18 mmHg or clinical evidence of left atrial hypertension. An unplanned ICU admission was defined as an admission planned less than 12 hours in advance or any unscheduled admission to the ICU that originated from the emergency department, general ward, operating room, or other location. Performance status was assigned a grade between 0 and 4 according to the Eastern Cooperative Oncology Group performance status classification [11]. We used the definition of variables employed in the original SAPS3 model to define variables in this study [12].
Statistical Analysis
Data are presented as median and interquartile range (25th and 75th percentiles) for continuous variables and as numbers (percentages) for categorical variables. Data were compared using the Mann-Whitney U-test for continuous variables and the chi-square or Fisher exact test for categorical variables, respectively, where applicable. Logistic regression analyses were performed to identify risk factors for the prediction of mortality. Variables that appeared to be related in the univariate analysis with a P-value of less than 0.2 were introduced into multivariate regression models using a forward stepwise method. For all analyses, a two-tailed test with a P-value of less than 0.05 was considered to be statistically significant. We used the SPSS version 20.0 (IBM SPSS Corp., Armonk, NY, USA) for statistical analysis.
Baseline Clinical Characteristics
As shown in Figure 1, a total of 1,762 cancer patients were admitted to the ICUs and 833 of them were deemed eligible for analysis. The baseline characteristics of the 833 eligible patients finally included in the present study are described in Table 1. Of these, 554 (66.5%) were male, and the median age was 63 years (range, 53 to 72 years). SOFA score and SAPS3 were 9 (range, 5 to 12) and 69 (range, 60 to 79), respectively. Unplanned admissions composed 74.4% of all ICU admissions. The most common reason for ICU admission was respiratory disease (30.1%), followed by surveillance (27.3%), cardiovascular disease (24.1%), and digestive disease (5.4%). About half of the patients included in this study had acute infection at the time of ICU admission, and most admissions were not related to surgery.
Comparison of Baseline Characteristics According to Type of Malignancy
Of the 833 patients, 658 (79%) had solid tumors and 175 (21%) had hematologic malignancies. The patients with solid tumors were typically older and more commonly male versus the patients with hematologic malignancies (Table 2). Performance status and comorbidities were similar between the two groups, except with regard to hypertension and liver cirrhosis. Patients with hematologic malignancies had higher SOFA and SAPS3 values than did patients with solid tumors. The proportions of patients with a history of chemotherapy (57.1% vs. 32.1%, P<0.001), steroid therapy (9.1% vs. 2.0%, P<0.001), and compromised immune status (17.7% vs. 7.3%, P<0.001) were significantly higher in the hematologic malignancies group, while, conversely, the proportion of patients who had undergone radiotherapy (13.8% vs. 8.0%, P=0.040) was higher in the solid tumor group. Unplanned ICUs admissions occurred more frequently among hematologic malignancy patients than among solid tumor patients. Respiratory (35.4% vs. 28.7%, P=0.095) and cardiovascular (34.9% vs. 21.3%, P<0.001) problems were common causes of ICU admission in both groups, with the exception of admission for surveillance. More patients with hematologic cancer showed an acute infection status at the time of ICU admission. In addition, rates of severe sepsis/septic shock were significantly higher in patients with hematologic cancer as compared with those with solid cancer (57.1% vs. 32.2%, P<0.001).
ICU Treatments
The amount of total fluid administered within 24 hours (4,039 ml vs. 3,339 ml, P<0.001) was higher and the use of an inotrope/vasopressor (54.8% vs. 44.7%, P=0.017) was more prevalent, respectively, in patients with hematologic malignancies. In addition, hematologic malignancy patients more frequently required mechanical ventilation (46.9% vs. 33.3%, P=0.001) and continuous renal replacement therapy (17.6% vs. 9.5%, P=0.004) than did solid tumor patients.
Clinical Outcomes
Overall, 235 patients (28.2%) died in the ICU, while 112 patients (13.4%) died while hospitalized in other wards (Figure 2). Both ICU (41.7% vs. 24.6%, P<0.001) and hospital (53.1% vs. 38.6%, P=0.002) mortality rates were significantly higher in patients with hematologic malignancies than in patients with solid tumors. Multivariable logistic regression analysis revealed that age, demonstration of performance status 2 through 4, mechanical ventilation usage, and SAPS3 in solid tumor patients (Table 3) and mechanical ventilation usage and SAPS3 in hematologic malignancy patients were significant prognostic predictors for hospital mortality (Table 3).
In the total patient cohort, ICU length of stay and hospital length of stay were 5 days (range, 3 to 10 days) and 20 days (range, 11 to 39 days), respectively. Although the ICU length of stay (5 days vs. 6 days, P=0.160) was similar between patients with solid tumor and those with hematologic malignancies, the hospital length of stay (28 days vs. 19 days, P=0.001) was noticeably longer in hematologic malignancy patients.
In this study, we investigated the epidemiology, characteristics, and clinical outcomes of critically ill cancer patients in Korea. Within our cohort, patients with cancer accounted for 34.8% of the total number of patients admitted to participating ICUs during the study period, and respiratory and cardiovascular diseases were two of the common causes of ICU admission in patients with malignancies. Our percentage of cancer patients admitted was relatively higher than those seen in the results of other previous studies that were conducted involving a mixed population, which ranged from 13.5% to 21.5% of overall ICU admissions [5,13,14]. Although it is difficult to compare our results to those of other investigations directly because our study did not examine the details of cancer, geographic variations in incidence and type of cancer may have an effect on the gap in the proportion of cancer patients admitted to the ICU [7].
Acute respiratory failure was identified as one of the most common medical conditions causing cancer patients to enter the ICU in previous studies as well as in our study [13,15,16]. The incidence of acute respiratory failure in cancer patients ranges from 10% to 50%, and the risk of respiratory failure is higher in patients with hematologic malignancies, especially in patients who received allogeneic stem cell transplantation, as compared with in patients with solid tumor [6,17,18]. The most common cause of acute respiratory failure is pulmonary infection, but treatment-associated pulmonary toxicities, transfusion-related acute lung injury, lung involvement of underlying malignancy, and malignant airway obstruction also can cause a case of acute respiratory failure that requires ICU management [18].
Patients with hematologic malignancies have some clinical characteristics different from those of patients with solid tumor [13]. In our study, the proportion of patients who received chemotherapy and steroid therapy and that of patients with immunosuppression were higher, and observations of acute infection and severe sepsis/septic shock at the time of ICU admission were more frequent in patients with hematologic malignancies than in patients with solid tumor. In addition to a higher baseline SOFA score, the frequencies of vasopressor use, mechanical ventilation, and continuous renal replacement therapy during ICU treatment were all significantly higher in patients with hematologic malignancies. These findings are consistent with those of previous studies that showed that patients with hematologic malignancies are more likely to develop severe sepsis or septic shock in comparison with patients with solid tumor [13]. Neutropenia often occurs in hematologic malignancy patients due to an association with the underlying malignancy itself or chemotherapy; for example, in our study, the white blood cell counts in hematologic malignancy patients were significantly lower than those in solid tumor patients, and it is known that neutropenic patients are more vulnerable to bacterial or fungal infections that have the potential to cause sepsis [19,20].
Also, in regard to prognosis, solid tumor patients and hematologic malignancy patients showed different results. Although variations exist with regard to the type of cancer, patients with solid tumor have a global hospital mortality rate of 25% to 40%, and some studies have demonstrated that mortality in this population is similar to that in ICU patients without cancer [14,21]. On the other hand, the hospital mortality rate of patients with hematologic malignancies is about 40% to 70%, which is generally worse than that in solid tumor patients [6,22]. In particular, the mortality rate of patients with hematologic malignancies who receive hematopoietic stem cell transplantation is concerning, even in recent studies, at 63% to 75% [23,24]. Hospital mortality rates in solid tumor patients and hematologic malignancy patients in our study were 38.6% and 53.1%, respectively, which were similar to results reported in other countries.
SOFA score, multiple organ failure, the provision of organ support such as vasopressor use or mechanical ventilation, and allogeneic hematopoietic stem cell transplantation are known to be predictors of mortality in patients with cancer [21,22,25,26]. We also confirmed that higher SAPS3 value and mechanical ventilation support were associated with poor prognosis in both solid tumor and hematologic malignancy patients. Furthermore, age and premorbid performance status were independent prognostic factors for hospital mortality in patients with solid tumor. Some studies have demonstrated that advanced or recurrent cancer is a variable associated with poor outcomes, but others have suggested that cancer status generally does not affect the short-term outcomes of critically ill cancer patients [25,27,28]. Therefore, intensivists need to be careful when considering cancer status in deciding whether to pursue ICU admission for cancer patients.
Although our study investigated the clinical and treatment characteristics, outcomes, and variables associated with mortality in cancer patients admitted to the 22 medical and surgical ICUs in the Korea, there are several limitations that should be considered. First, our study did not record detailed data about the type, disease status, and treatment of cancer. Although some recent studies have suggested that the disease status of cancer does not adversely affect the short-term outcomes of cancer patients admitted to the ICU, progressive cancer or certain specific conditions, such as those that require mechanical ventilation for respiratory failure due to tumor involvement, are associated with poor prognosis [25]. Therefore, further studies that include additional information on disease status should be conducted to elucidate more accurately the characteristics of and to assess the clinical outcomes in critically ill cancer patients. Also, data about the code status at the time of ICU admission and change(s) in code status during ICU management, which may influence therapeutic decisions and mortality, were not collected. Finally, analyses comparing the cancer patients admitted to the ICU with cancer patients not admitted to the ICU were not performed, and we could not determine whether ICU management is beneficial in cancer patients with acute deterioration.
In conclusion, the proportion of patients with cancer is higher in Korea than in other countries, accounting for about onethird of all patients admitted to the ICU. The most common reason for ICU admission in nonsurgical cancer patients was respiratory problems. Patients with hematologic malignancies had higher severity scores and rates of organ support treatment and mortality than did those with solid tumor. Mechanical ventilation and SAPS3 were independent predictors of hospital mortality in both solid tumor and hematologic malignancy patients.
▪ Cancer patients accounted for one-third of all patients admitted to the studied intensive care units in Korea.
▪ Clinical characteristics were different according to the type of malignancy.
▪ Patients with hematologic malignancies had a worse prognosis than did patients with solid tumor.

No potential conflict of interest relevant to this article was reported.

Figure 1.
A schematic of study participant flow. ICU: intensive care unit.
acc-2018-00143f1.jpg
Figure 2.
A comparison of intensive care unit (ICU) and hospital mortality.
acc-2018-00143f2.jpg
Table 1.
Baseline characteristics of cancer patients admitted to the ICU
Characteristics Value
Age (yr) 63 (53-72)
Male sex 554 (66.5)
ECOG performance statusa
 0-1 349 (44.4)
 2-4 438 (55.6)
Comorbidity
 Hypertension 219 (26.3)
 Diabetes 153 (18.4)
 Congestive heart failure 30 (3.6)
 Stroke 35 (4.2)
 Chronic lung disease 14 (1.7)
 Liver cirrhosis 97 (11.6)
 Chronic renal failure 42 (5.0)
Severity of illness
 SOFA 9 (5-12)
 SAPS3 69 (60-79)
Location before ICU admission
 Emergency room 377 (45.3)
 General ward 429 (51.5)
 Other ICU 20 (2.4)
 Other 7 (0.8)
Treatment history before ICU admission
 Chemotherapy 311 (37.3)
 Radiotherapy 105 (12.6)
 Steroid 29 (3.5)
Immune suppression status 79 (9.5)
CPR before ICU admission 44 (5.3)
Unplanned ICU admission 620 (74.4)
Reason for admission
 Surveillance 228 (27.3)
 Cardiovascular 201 (24.1)
 Respiratory 251 (30.1)
 Neurological 29 (3.5)
 Hepatic 29 (3.5)
 Digestive 45 (5.4)
 Renal 9 (1.1)
 Metabolic 12 (1.4)
 Hematological 5 (0.6)
 Otherb 24 (2.9)
Acute infection at ICU admission 427 (51.3)
 Severe sepsis/septic shock 312 (37.5)
Surgical status at ICU admission
 No surgery 736 (88.4)
 Emergent surgery 97 (11.6)

Values are presented as median (interquartile range) or number (%). ICU: intensive care unit; ECOG: Eastern Cooperative Oncology Group; SOFA: Sequential Organ Failure Assessment; SAPS3: Simplified Acute Physiology Score 3; CPR: cardiopulmonary resuscitation.

aData were available for 787 patients;

bIncludes patients with spinal stenosis, trauma, urinary incontinence, and mood depression disorder.

Table 2.
Baseline and treatment characteristics according to type of malignancy
Variable Solid tumor (n = 658) Hematologic malignancies (n=175) P-value
Age (yr) 65 (55-73) 55 (42-65) 0.005
Male sex 452 (70.2) 102 (58.6) 0.005
ECOG performance statusa 0.928
 0-1 271 (44.2) 78 (44.6)
 2-4 342 (55.8) 96 (54.9)
Comorbidity (overlapped)
 Hypertension 191 (29.0) 28 (16.0) 0.001
 Diabetes 121 (18.4) 32 (18.3) >0.999
 Congestive heart failure 21 (3.2) 9 (5.1) 0.251
 Stroke 28 (4.3) 7 (4.0) >0.999
 Chronic lung disease 11 (1.7) 3 (1.7) >0.999
 Liver cirrhosis 93 (14.1) 4 (2.3) <0.001
 Chronic renal failure 32 (4.9) 10 (5.7) 0.703
Severity of illness
 SOFA 8 (4-12) 12 (8-15) <0.001
 SAPS3 69 (60-79) 71 (63-82) <0.001
Location before ICU admission <0.001
 Emergency room 323 (49.1) 54 (30.9)
 General ward 314 (47.7) 115 (65.7)
 Other ICU 15 (2.3) 5 (2.9)
 Otherb 6 (0.9) 1 (0.6)
Hospital days before ICU admission 0 (0-2) 0 (0-9) 0.008
Treatment history before ICU admission
 Chemotherapy 211 (32.1) 100 (57.1) <0.001
 Radiotherapy 91 (13.8) 14 (8.0) 0.040
 Steroid 13 (2.0) 16 (9.1) <0.001
Immune suppression status 48 (7.3) 31 (17.7) <0.001
CPR before ICU admission 26 (4.2) 18 (10.5) 0.001
Unplanned ICU admission 469 (71.3) 151 (86.3) <0.001
Reason for ICU admission
 Surveillance 190 (28.9) 38 (21.7) 0.070
 Cardiovascular 140 (21.3) 61 (34.9) <0.001
 Digestive 45 (6.8) 0 0.001
 Hematological 3 (0.5) 2 (1.1) 0.283
 Hepatic failure 29 (4.4) 0 0.004
 Metabolic 12 (1.8) 0 0.081
 Neurological 20 (3.0) 9 (5.1) 0.243
 Renal 7 (1.1) 2 (1.1) 1.000
 Respiratory 189 (28.7) 62 (35.4) 0.095
 Other 20 (3.0) 1 (0.6) 0.098
Acute infection at ICU admission 298 (45.3) 129 (73.7) <0.001
 Severe sepsis/septic shock 212 (32.2) 100 (57.1) <0.001
Surgical status at ICU admission <0.001
 No surgery 566 (86.0) 170 (97.1)
 Emergent surgery 92 (14.0) 5 (2.9)
Initial laboratory variable
 White blood cell (mm3) 9,750 (5,320-15,460) 3,640 (250-9,850) <0.001
 Total bilirubin (mg/dl) 0.9 (0.6-2.1) 1.1 (0.7-2.3) 0.297
 Creatinine (mg/dl) 1.0 (0.7-1.6) 1.1 (0.7-1.8) 0.381
 Arterial pH 7.39 (7.30-7.45) 7.40 (7.30-7.46) 0.159
 Lactic acid (mmol/l) 2.90 (1.70-5.40) 2.65 (1.50-5.23) 0.468
 C-reactive protein (mg/dl) 12.3 (4.3-21.3) 14.5 (6.3-24.3) 0.082
 Procalcitonin (ng/ml) 3.64 (0.65-22.87) 8.12 (0.19-27.12) 0.988
 NT-proBNP (pg/ml) 681 (161-3039) 965 (315-6070) 0.019
Treatment
 Total infused fluids within 24 hr (ml) 3,339 (2,275-4,775) 4,039 (3,001-5,246) <0.001
 Inotrope/vasopressor within 24 hr 293 (44.7) 96 (54.8) 0.017
  Norepinephrine 251 (38.4) 84 (48.8) 0.012
  Vasopressin 53 (8.3) 29 (17.2) 0.001
  Dopamine 64 (10.0) 19 (11.3) 0.631
  Dobutamine 51 (7.9) 20 (11.8) 0.108
  Epinephrine 5 (0.8) 2 (1.2) 0.643
 Mechanical ventilation 219 (33.3) 82 (46.9) 0.001
 Continuous renal replacement therapy 60 (9.5) 30 (17.6) 0.004

Values are presented as median (interquartile range) or number (%).

ECOG: Eastern Cooperative Oncology Group; SOFA: Sequential Organ Failure Assessment; SAPS3: Simplified Acute Physiology Score 3; ICU: intensive care unit; CPR: cardiopulmonary resuscitation; NT-proBNP: N-terminal prohormone of brain natriuretic peptide.

aData were available for 787 patients;

bIncludes patients with spinal stenosis, trauma, urinary incontinence, and mood depression disorder.

Table 3.
Prognostic factors for hospital mortality
Variable Adjusted OR 95% CI P-value
Patient with solid tumor
 Age 0.96 0.93-0.99 0.019
 ECOG performance status 2-4 2.63 1.29-5.37 0.008
 Mechanical ventilation 2.85 1.35-6.04 0.006
 SAPS3 1.07 1.04-1.10 <0.001
Patient with hematologic malignancies
 SAPS3 1.05 1.01-1.08 0.006
 Mechanical ventilation 2.41 1.05-5.55 0.039

OR: odds ratio; CI: confidence interval; ECOG: Eastern Cooperative Oncology Group; SAPS3: Simplified Acute Physiology Score 3.

  • 1. van Vliet M, Verburg IW, van den Boogaard M, de Keizer NF, Peek N, Blijlevens NM, et al. Trends in admission prevalence, illness severity and survival of haematological patients treated in Dutch intensive care units. Intensive Care Med 2014;40:1275-84.ArticlePubMed
  • 2. Garrouste-Orgeas M, Montuclard L, Timsit JF, Reignier J, Desmettre T, Karoubi P, et al. Predictors of intensive care unit refusal in French intensive care units: a multiple-center study. Crit Care Med 2005;33:750-5.ArticlePubMed
  • 3. Schuster DP, Marion JM. Precedents for meaningful recovery during treatment in a medical intensive care unit: outcome in patients with hematologic malignancy. Am J Med 1983;75:402-8.ArticlePubMed
  • 4. Jackson SR, Tweeddale MG, Barnett MJ, Spinelli JJ, Sutherland HJ, Reece DE, et al. Admission of bone marrow transplant recipients to the intensive care unit: outcome, survival and prognostic factors. Bone Marrow Transplant 1998;21:697-704.ArticlePubMedPDF
  • 5. Soares M, Caruso P, Silva E, Teles JM, Lobo SM, Friedman G, et al. Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med 2010;38:9-15.ArticlePubMed
  • 6. Azoulay E, Mokart D, Pène F, Lambert J, Kouatchet A, Mayaux J, et al. Outcomes of critically ill patients with hematologic malignancies: prospective multicenter data from France and Belgium. A groupe de recherche respiratoire en réanimation onco-hématologique study. J Clin Oncol 2013;31:2810-8.ArticlePubMed
  • 7. Torre LA, Siegel RL, Ward EM, Jemal A. Global cancer incidence and mortality rates and trends: an update. Cancer Epidemiol Biomarkers Prev 2016;25:16-27.ArticlePubMed
  • 8. Lim SY, Koh SO, Jeon K, Na S, Lim CM, Choi WI, et al. Validation of SAPS3 admission score and its customization for use in Korean intensive care unit patients: a prospective multicentre study. Respirology 2013;18:989-95.ArticlePubMed
  • 9. Metnitz PG, Moreno RP, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3: from evaluation of the patient to evaluation of the intensive care unit. Part 1: objectives, methods and cohort description. Intensive Care Med 2005;31:1336-44.ArticlePubMedPMC
  • 10. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6.ArticlePubMed
  • 11. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, Mc-Fadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-55.ArticlePubMed
  • 12. Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, et al. SAPS 3: from evaluation of the patient to evaluation of the intensive care unit. Part 2: development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med 2005;31:1345-55.ArticlePubMedPMC
  • 13. Staudinger T, Stoiser B, Müllner M, Locker GJ, Laczika K, Knapp S, et al. Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 2000;28:1322-8.ArticlePubMed
  • 14. Bos MM, de Keizer NF, Meynaar IA, Bakhshi-Raiez F, de Jonge E. Outcomes of cancer patients after unplanned admission to general intensive care units. Acta Oncol 2012;51:897-905.ArticlePubMed
  • 15. Darmon M, Thiery G, Ciroldi M, de Miranda S, Galicier L, Raffoux E, et al. Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 2005;33:2488-93.ArticlePubMed
  • 16. Hawari FI, Nazer LH, Addassi A, Rimawi D, Jamal K. Predictors of ICU admission in patients with cancer and the related characteristics and outcomes: a 5-year registry-based study. Crit Care Med 2016;44:548-53.ArticlePubMed
  • 17. Chi AK, Soubani AO, White AC, Miller KB. An update on pulmonary complications of hematopoietic stem cell transplantation. Chest 2013;144:1913-22.ArticlePubMed
  • 18. Pastores SM, Voigt LP. Acute respiratory failure in the patient with cancer: diagnostic and management strategies. Crit Care Clin 2010;26:21-40.ArticlePubMed
  • 19. Bhatt V, Saleem A. Review: drug-induced neutropenia. Pathophysiology, clinical features, and management. Ann Clin Lab Sci 2004;34:131-7.ArticlePubMedPDF
  • 20. Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Ann Intern Med 1966;64:328-40.ArticlePubMed
  • 21. Puxty K, McLoone P, Quasim T, Sloan B, Kinsella J, Morrison DS. Risk of critical illness among patients with solid cancers: a population-based observational study. JAMA Oncol 2015;1:1078-85.ArticlePubMed
  • 22. Depuydt PO, Benoit DD, Vandewoude KH, Decruyenaere JM, Colardyn FA. Outcome in noninvasively and invasively ventilated hematologic patients with acute respiratory failure. Chest 2004;126:1299-306.ArticlePubMed
  • 23. Platon L, Amigues L, Ceballos P, Fegueux N, Daubin D, Besnard N, et al. A reappraisal of ICU and long-term outcome of allogeneic hematopoietic stem cell transplantation patients and reassessment of prognosis factors: results of a 5-year cohort study (2009-2013). Bone Marrow Transplant 2016;51:256-61.ArticlePubMedPDF
  • 24. Depuydt P, Kerre T, Noens L, Nollet J, Offner F, Decruyenaere J, et al. Outcome in critically ill patients with allogeneic BM or peripheral haematopoietic SCT: a single-centre experience. Bone Marrow Transplant 2011;46:1186-91.ArticlePubMedPDF
  • 25. Azevedo LC, Caruso P, Silva UV, Torelly AP, Silva E, Rezende E, et al. Outcomes for patients with cancer admitted to the ICU requiring ventilatory support: results from a prospective multicenter study. Chest 2014;146:257-66.ArticlePubMed
  • 26. Pène F, Aubron C, Azoulay E, Blot F, Thiéry G, Raynard B, et al. Outcome of critically ill allogeneic hematopoietic stemcell transplantation recipients: a reappraisal of indications for organ failure supports. J Clin Oncol 2006;24:643-9.ArticlePubMed
  • 27. Soares M, Salluh JI, Spector N, Rocco JR. Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs. Crit Care Med 2005;33:520-6.ArticlePubMed
  • 28. Peigne V, Rusinová K, Karlin L, Darmon M, Fermand JP, Schlemmer B, et al. Continued survival gains in recent years among critically ill myeloma patients. Intensive Care Med 2009;35:512-8.ArticlePubMed

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Outcomes of Acute Respiratory Failure in Patients With Cancer in the United States
      Kiyan Heybati, Jiawen Deng, Archis Bhandarkar, Fangwen Zhou, Cameron Zamanian, Namrata Arya, Mohamad Bydon, Philippe R. Bauer, Ognjen Gajic, Allan J. Walkey, Hemang Yadav
      Mayo Clinic Proceedings.2024; 99(4): 578.     CrossRef
    • Characteristics and outcomes of cancer patients admitted to intensive care units in cancer specialized hospitals in China
      Wensheng Liu, Dongmin Zhou, Li Zhang, Mingguang Huang, Rongxi Quan, Rui Xia, Yong Ye, Guoxing Zhang, Zhuping Shen
      Journal of Cancer Research and Clinical Oncology.2024;[Epub]     CrossRef
    • Short-term and long-term outcomes of critically ill patients with solid malignancy: a retrospective cohort study
      Su Yeon Lee, Jin Won Huh, Sang-Bum Hong, Chae-Man Lim, Jee Hwan Ahn
      The Korean Journal of Internal Medicine.2024; 39(6): 957.     CrossRef
    • Predictors of ICU mortality in patients with hemoblastosis and infectious complications
      A.V. Lyanguzov, A.S. Luchinin, S.V. Ignatyev, I.V. Paramonov
      Anesteziologiya i reanimatologiya.2023; (1): 33.     CrossRef
    • Effect of the underlying malignancy on critically ill septic patient's outcome
      Man‐Yee Man, Hoi‐Ping Shum, Sin‐Man Lam, Jacky Li, Wing‐Wa Yan, Mei‐Wan Yeung
      Asia-Pacific Journal of Clinical Oncology.2022; 18(4): 473.     CrossRef
    • Impacts of Corticosteroid Therapy at Acute Stage of Hospital-Onset Clostridioides difficile Infections
      Ching-Chi Lee, Jen-Chieh Lee, Chun-Wei Chiu, Pei-Jane Tsai, Wen-Chien Ko, Yuan-Pin Hung
      Infection and Drug Resistance.2022; Volume 15: 5387.     CrossRef
    • Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy
      Da Woon Kim, Geum Suk Jang, Kyoung Suk Jung, Hyuk Jae Jung, Hyo Jin Kim, Harin Rhee, Eun Young Seong, Sang Heon Song
      Kidney Research and Clinical Practice.2022; 41(6): 717.     CrossRef
    • A Systematic Review and Meta-Analysis Evaluating Geographical Variation in Outcomes of Cancer Patients Treated in ICUs
      Lama H. Nazer, Maria A. Lopez-Olivo, Anne Rain Brown, John A. Cuenca, Michael Sirimaturos, Khader Habash, Nada AlQadheeb, Heather May, Victoria Milano, Amy Taylor, Joseph L. Nates
      Critical Care Explorations.2022; 4(9): e0757.     CrossRef
    • Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study
      Jigeeshu Divatia, Amit M Narkhede, Harish K Chaudhari, Ujwal Dhundi, Natesh Prabu Ravisankar, Satish Sarode
      Indian Journal of Critical Care Medicine.2021; 25(12): 1421.     CrossRef

    • PubReader PubReader
    • ePub LinkePub Link
    • Cite
      CITE
      export Copy
      Close
      Download Citation
      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

      Format:
      • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
      • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
      Include:
      • Citation for the content below
      Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units
      Acute Crit Care. 2018;33(3):121-129.   Published online August 31, 2018
      Close
    • XML DownloadXML Download
    Figure
    • 0
    • 1
    Related articles
    Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units
    Image Image
    Figure 1. A schematic of study participant flow. ICU: intensive care unit.
    Figure 2. A comparison of intensive care unit (ICU) and hospital mortality.
    Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units
    Characteristics Value
    Age (yr) 63 (53-72)
    Male sex 554 (66.5)
    ECOG performance statusa
     0-1 349 (44.4)
     2-4 438 (55.6)
    Comorbidity
     Hypertension 219 (26.3)
     Diabetes 153 (18.4)
     Congestive heart failure 30 (3.6)
     Stroke 35 (4.2)
     Chronic lung disease 14 (1.7)
     Liver cirrhosis 97 (11.6)
     Chronic renal failure 42 (5.0)
    Severity of illness
     SOFA 9 (5-12)
     SAPS3 69 (60-79)
    Location before ICU admission
     Emergency room 377 (45.3)
     General ward 429 (51.5)
     Other ICU 20 (2.4)
     Other 7 (0.8)
    Treatment history before ICU admission
     Chemotherapy 311 (37.3)
     Radiotherapy 105 (12.6)
     Steroid 29 (3.5)
    Immune suppression status 79 (9.5)
    CPR before ICU admission 44 (5.3)
    Unplanned ICU admission 620 (74.4)
    Reason for admission
     Surveillance 228 (27.3)
     Cardiovascular 201 (24.1)
     Respiratory 251 (30.1)
     Neurological 29 (3.5)
     Hepatic 29 (3.5)
     Digestive 45 (5.4)
     Renal 9 (1.1)
     Metabolic 12 (1.4)
     Hematological 5 (0.6)
     Otherb 24 (2.9)
    Acute infection at ICU admission 427 (51.3)
     Severe sepsis/septic shock 312 (37.5)
    Surgical status at ICU admission
     No surgery 736 (88.4)
     Emergent surgery 97 (11.6)
    Variable Solid tumor (n = 658) Hematologic malignancies (n=175) P-value
    Age (yr) 65 (55-73) 55 (42-65) 0.005
    Male sex 452 (70.2) 102 (58.6) 0.005
    ECOG performance statusa 0.928
     0-1 271 (44.2) 78 (44.6)
     2-4 342 (55.8) 96 (54.9)
    Comorbidity (overlapped)
     Hypertension 191 (29.0) 28 (16.0) 0.001
     Diabetes 121 (18.4) 32 (18.3) >0.999
     Congestive heart failure 21 (3.2) 9 (5.1) 0.251
     Stroke 28 (4.3) 7 (4.0) >0.999
     Chronic lung disease 11 (1.7) 3 (1.7) >0.999
     Liver cirrhosis 93 (14.1) 4 (2.3) <0.001
     Chronic renal failure 32 (4.9) 10 (5.7) 0.703
    Severity of illness
     SOFA 8 (4-12) 12 (8-15) <0.001
     SAPS3 69 (60-79) 71 (63-82) <0.001
    Location before ICU admission <0.001
     Emergency room 323 (49.1) 54 (30.9)
     General ward 314 (47.7) 115 (65.7)
     Other ICU 15 (2.3) 5 (2.9)
     Otherb 6 (0.9) 1 (0.6)
    Hospital days before ICU admission 0 (0-2) 0 (0-9) 0.008
    Treatment history before ICU admission
     Chemotherapy 211 (32.1) 100 (57.1) <0.001
     Radiotherapy 91 (13.8) 14 (8.0) 0.040
     Steroid 13 (2.0) 16 (9.1) <0.001
    Immune suppression status 48 (7.3) 31 (17.7) <0.001
    CPR before ICU admission 26 (4.2) 18 (10.5) 0.001
    Unplanned ICU admission 469 (71.3) 151 (86.3) <0.001
    Reason for ICU admission
     Surveillance 190 (28.9) 38 (21.7) 0.070
     Cardiovascular 140 (21.3) 61 (34.9) <0.001
     Digestive 45 (6.8) 0 0.001
     Hematological 3 (0.5) 2 (1.1) 0.283
     Hepatic failure 29 (4.4) 0 0.004
     Metabolic 12 (1.8) 0 0.081
     Neurological 20 (3.0) 9 (5.1) 0.243
     Renal 7 (1.1) 2 (1.1) 1.000
     Respiratory 189 (28.7) 62 (35.4) 0.095
     Other 20 (3.0) 1 (0.6) 0.098
    Acute infection at ICU admission 298 (45.3) 129 (73.7) <0.001
     Severe sepsis/septic shock 212 (32.2) 100 (57.1) <0.001
    Surgical status at ICU admission <0.001
     No surgery 566 (86.0) 170 (97.1)
     Emergent surgery 92 (14.0) 5 (2.9)
    Initial laboratory variable
     White blood cell (mm3) 9,750 (5,320-15,460) 3,640 (250-9,850) <0.001
     Total bilirubin (mg/dl) 0.9 (0.6-2.1) 1.1 (0.7-2.3) 0.297
     Creatinine (mg/dl) 1.0 (0.7-1.6) 1.1 (0.7-1.8) 0.381
     Arterial pH 7.39 (7.30-7.45) 7.40 (7.30-7.46) 0.159
     Lactic acid (mmol/l) 2.90 (1.70-5.40) 2.65 (1.50-5.23) 0.468
     C-reactive protein (mg/dl) 12.3 (4.3-21.3) 14.5 (6.3-24.3) 0.082
     Procalcitonin (ng/ml) 3.64 (0.65-22.87) 8.12 (0.19-27.12) 0.988
     NT-proBNP (pg/ml) 681 (161-3039) 965 (315-6070) 0.019
    Treatment
     Total infused fluids within 24 hr (ml) 3,339 (2,275-4,775) 4,039 (3,001-5,246) <0.001
     Inotrope/vasopressor within 24 hr 293 (44.7) 96 (54.8) 0.017
      Norepinephrine 251 (38.4) 84 (48.8) 0.012
      Vasopressin 53 (8.3) 29 (17.2) 0.001
      Dopamine 64 (10.0) 19 (11.3) 0.631
      Dobutamine 51 (7.9) 20 (11.8) 0.108
      Epinephrine 5 (0.8) 2 (1.2) 0.643
     Mechanical ventilation 219 (33.3) 82 (46.9) 0.001
     Continuous renal replacement therapy 60 (9.5) 30 (17.6) 0.004
    Variable Adjusted OR 95% CI P-value
    Patient with solid tumor
     Age 0.96 0.93-0.99 0.019
     ECOG performance status 2-4 2.63 1.29-5.37 0.008
     Mechanical ventilation 2.85 1.35-6.04 0.006
     SAPS3 1.07 1.04-1.10 <0.001
    Patient with hematologic malignancies
     SAPS3 1.05 1.01-1.08 0.006
     Mechanical ventilation 2.41 1.05-5.55 0.039
    Table 1. Baseline characteristics of cancer patients admitted to the ICU

    Values are presented as median (interquartile range) or number (%). ICU: intensive care unit; ECOG: Eastern Cooperative Oncology Group; SOFA: Sequential Organ Failure Assessment; SAPS3: Simplified Acute Physiology Score 3; CPR: cardiopulmonary resuscitation.

    Data were available for 787 patients;

    Includes patients with spinal stenosis, trauma, urinary incontinence, and mood depression disorder.

    Table 2. Baseline and treatment characteristics according to type of malignancy

    Values are presented as median (interquartile range) or number (%).

    ECOG: Eastern Cooperative Oncology Group; SOFA: Sequential Organ Failure Assessment; SAPS3: Simplified Acute Physiology Score 3; ICU: intensive care unit; CPR: cardiopulmonary resuscitation; NT-proBNP: N-terminal prohormone of brain natriuretic peptide.

    Data were available for 787 patients;

    Includes patients with spinal stenosis, trauma, urinary incontinence, and mood depression disorder.

    Table 3. Prognostic factors for hospital mortality

    OR: odds ratio; CI: confidence interval; ECOG: Eastern Cooperative Oncology Group; SAPS3: Simplified Acute Physiology Score 3.


    ACC : Acute and Critical Care
    TOP