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Intensive Care Medicine

, Volume 36, Issue 2, pp 232–240 | Cite as

Central neurological complications in critically ill patients with malignancies

  • Stéphane Legriel
  • Hélène Marijon
  • Michael Darmon
  • Virginie Lemiale
  • Jean-Pierre Bedos
  • Benoît Schlemmer
  • Elie AzoulayEmail author
Original

Abstract

Objective

To determine outcomes in critically ill patients hospitalized in the ICU for central neurological complications of cancer.

Design and setting

A 7-year retrospective study.

Subject and intervention

Observational study in 100 critically ill cancer patients with central neurological complications managed using standardized diagnostic and therapeutic strategies.

Measurements and results

There were 52 men and 48 women, aged 55 years (IQR, 40–65). Presenting manifestations were coma (56%), epilepsy (48%), focal signs (35%), encephalopathy (31%), and meningitis (7%). Cerebral imaging was abnormal in 61 patients, lumbar puncture in 17, and electroencephalography in 6. Neurosurgical biopsy was performed on four patients. The main etiologies included drug toxicity in 28, malignant brain infiltration in 21 patients, and cerebrovascular disease in 20. Mechanical ventilation was needed for 60 patients. Anticancer chemotherapy was administered during the ICU stay in 15 patients. ICU and hospital mortalities were 28 and 45%, respectively. By multivariate analysis, independent positive predictors of hospital mortality were poor performance status [odds ratio (OR) 2.94, 95% CI, 1.01–8.55, P = 0.047), focal signs at presentation (OR 3.52, 95% CI, 1.14–10.88, P = 0.029), abnormal lumbar puncture (OR 5.49, 95% CI 1.09–27.66, P = 0.038), and need for vasoactive drugs (OR 6.47, 95% CI 1.32–31.66, P = 0.021), whereas remission of the malignancy (OR 0.20, 95% CI 0.04–0.88, P = 0.033) and GCS score at admission (OR 0.81/point, 95% CI, 0.70–0.95, P = 0.009) were negative predictors of hospital mortality.

Conclusion

In cancer patients, central neurological events are mainly related to malignant brain infiltration and drug-related toxicity. Despite advanced severity, a standardized intensive management strategy yields a 55% hospital survival rate.

Keywords

Leukemia Lymphoma Bone marrow transplantation Mechanical ventilation ICU Cancer 

Notes

Acknowledgments

The authors thank Antoinette Wolfe, MD, for helping to prepare the manuscript. Presented in part at the 36th Congress of the French Society for Critical Care (2008), Paris, France.

Conflicts of interest statement

The authors have no conflict of interest.

Supplementary material

134_2009_1709_MOESM1_ESM.doc (33 kb)
(DOC 33 kb)
134_2009_1709_MOESM2_ESM.doc (58 kb)
(DOC 58 kb)
134_2009_1709_MOESM3_ESM.doc (37 kb)
(DOC 37 kb)

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Copyright information

© Copyright jointly hold by Springer and ESICM 2009

Authors and Affiliations

  • Stéphane Legriel
    • 1
    • 2
  • Hélène Marijon
    • 1
    • 2
  • Michael Darmon
    • 1
    • 2
  • Virginie Lemiale
    • 1
    • 2
  • Jean-Pierre Bedos
    • 1
    • 2
  • Benoît Schlemmer
    • 1
    • 2
  • Elie Azoulay
    • 1
    • 2
    • 3
    Email author
  1. 1.Medical Intensive Care Unit, AP-HPHôpital Saint-LouisParisFrance
  2. 2.UFR de MédecineUniversity Paris-7 Paris-DiderotParisFrance
  3. 3.Service de Réanimation MédicaleHôpital Saint-Louis et Université Paris 7ParisFrance

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