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Prognosis of patients with primary malignant brain tumors admitted to the intensive care unit: a two-decade experience

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Abstract

The purpose of this study is to describe the reasons for ICU admission and to evaluate the outcome and prognostic factors of patients with primary malignant brain tumors (PMBT) admitted to the intensive care unit (ICU). This is a retrospective observational cohort study of 196 PMBT patients admitted to two ICUs over a 19-year period. Acute respiratory failure was the main reason for ICU admission (45%) followed by seizures (25%) and non-epileptic coma (14%). Seizures were more common in patients with glial lesions (84 vs. 67%), whereas patients with primary brain lymphoma were more frequently admitted for shock (42 vs. 18%). Overall ICU and 90-day mortality rates were 23 and 50%, respectively. Admission for seizures was independently associated with lower ICU mortality [odds ratio (OR) 0.06], whereas the need for mechanical ventilation (OR 6.85), cancer progression (OR 7.84), respiratory rate (OR 1.11) and Glasgow coma scale (OR 0.85) were associated with higher ICU mortality. Among the 95 patients who received invasive mechanical ventilation, ICU mortality was 37% (n = 35). For these patients, admission for seizures was associated with lower ICU mortality (OR 0.050) whereas cancer progression (OR 7.49) and respiratory rate (OR 1.08) were associated with higher ICU mortality. The prognosis of PMBT patients admitted to the ICU appears relatively favorable compared to that of hematologic malignancies or solid tumors, especially when the patient is admitted for seizures. The presence of a PMBT, therefore, does not appear to be sufficient for refusal of ICU admission. Predictive factors of mortality may help clinicians make optimal triage decisions.

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Acknowledgements

We are immensely grateful to Professor Jean-Yves Delattre for his valuable comments and strong support. We thank Paul Robinson for his help with English style and grammar.

Author information

Authors and Affiliations

  1. Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS_1158, Paris, France

    Maxens Decavèle, Isabelle Rivals, Thomas Similowski & Alexandre Demoule

  2. Department of Respiratory and Critical Care Medicine, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département “R3S”), AP-HP, 47-83 Boulevard de l’Hôpital, 75013, Paris, France

    Maxens Decavèle, Hélène Prodanovic, Julien Mayaux, Thomas Similowski & Alexandre Demoule

  3. Unité de Réanimation Neurologique, Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Pôle des Maladies du Système Nerveux et Institut de Neurosciences Translationnelles, IHU-A-ICM, Paris, France

    Nicolas Weiss

  4. Equipe de Statistique Appliquée, ESPCI ParisTech, PSL Research University, Paris, France

    Isabelle Rivals

  5. Institut du Cerveau et de la Moelle Épinière, ICM, Inserm U 1127, CNRS, UMR 7225, Sorbonne Universités, UPMC Univ Paris 06, UMRS_1127, 75013, Paris, France

    Ahmed Idbaih

  6. Hôpitaux Universitaires La Pitié Salpêtrière, Charles Foix, Service de Neurologie 2-Mazarin, AP-HP, 75013, Paris, France

    Ahmed Idbaih

Authors
  1. Maxens Decavèle
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  2. Nicolas Weiss
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  3. Isabelle Rivals
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Contributions

Conception and design: Maxens Decavèle, Nicolas Weiss, Isabelle Rivals, Alexandre Demoule. Collection and assembly of data: Maxens Decavèle, Julien Mayaux, Hélène Prodanovic, Alexandre Demoule. Data analysis and interpretation: Maxens Decavèle, Isabelle Rivals, Alexandre Demoule, Thomas Similowski. Manuscript writing: Maxens Decavèle, Alexandre Demoule. Final approval: All authors.

Corresponding author

Correspondence to Alexandre Demoule.

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Ethical standards

Consent was not collected because of retrospective design. The study was approved by the Institutional Review Board of the French Intensive Care Society.

Conflicts of interest

Alexandre Demoule has signed research contracts with Covidien, Maquet, Philips and Ait Liquide Santé; he has also received personal fees from Covidien, Maquet and MSD. Ahmed Idbaih reports research funding from La Fondation ARC pour la recherche sur le Cancer, Carthera, Beta-Innov, and Intselchimos; travel funding from Hoffmann-La Roche; and personal fees from Novartis, La Lettre du Cancérologue, BMS, and Cipla unrelated to the submitted work. Nicolas Weiss has signed research contracts with Eumedica, BMS, MedDay pharmaceuticals; he has also received personal fees from Norgine and Alpha-Wasserman. Thomas Similowski has received Grant research from Coviden, Philips, Pierre Fabre Médicaments, Air Liquide Medical Systems; he has also received personal fees from Takeda, Teva Pharma, Lungpacer Inc, Almirall France, Pierre Fabre Médicaments, Novartis, Mundipharma, Invacare, Astra Zeneca, Boehringer Ingelheim and GlaxoSmithKline. Julien Mayaux declares that he has no conflict of interest. Hélène Prodanovic declares that she has no conflict of interest. Isabelle Rivals declares that she has no conflict of interest. Maxens Decavèle declares that he has no conflict of interest.

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Decavèle, M., Weiss, N., Rivals, I. et al. Prognosis of patients with primary malignant brain tumors admitted to the intensive care unit: a two-decade experience. J Neurol 264, 2303–2312 (2017). https://doi.org/10.1007/s00415-017-8624-7

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  • DOI: https://doi.org/10.1007/s00415-017-8624-7

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