Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units
- 859 Downloads
To determine whether earlier intervention was associated with decreased mortality in critically ill cancer patients admitted to an intensive care unit (ICU).
A retrospective observational study was performed of 199 critically ill cancer patients admitted to the ICU from the general ward between January 2010 and December 2010. A logistic regression model was used to adjust for potential confounding factors in the association between time to intervention and in-hospital mortality.
In-hospital mortality was 52 %, with a median Simplified Acute Physiology Score 3 (SAPS 3) of 80 [interquartile range (IQR) 67–93], and a median Sequential Organ Failure Assessment (SOFA) score of 8 (IQR 5–11). Median time from physiological derangement to intervention (time to intervention) prior to ICU admission was 1.5 (IQR 0.6–4.3) h. Median time to intervention was significantly shorter in survivors than in non-survivors (0.9 vs. 3.0 h; p < 0.001). Additionally, the mortality rates increased significantly with increasing quartiles of time to intervention (p < 0.001, test for trend). Other factors associated with in-hospital mortality were severity of illness, performance status, hematologic malignancy, stem-cell transplantation, presence of three or more abnormal physiological variables, time from derangement to ICU admission, presence of infection, need for mechanical ventilation and vasopressor, and low PaO2/FiO2 ratio. Even after adjusting for potential confounding factors, time to intervention was still significantly associated with hospital mortality (adjusted odds ratio 1.445, 95 % confidence interval 1.217–1.717).
Early intervention before ICU admission was independently associated with decreased in-hospital mortality in critically ill cancer patients admitted to the ICU.
KeywordsCritical illness Early intervention Cancer hospital Mortality
The authors thank the Samsung Medical Alarm Response Team (SMART) and the staff of the medical oncology intensive care unit for their enthusiasm and commitment to patient care.
- 11.Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, Auerbach A, Chen WJ, Duncan K, Kenward G, Bell M, Buist M, Chen J, Bion J, Kirby A, Lighthall G, Ovreveit J, Braithwaite RS, Gosbee J, Milbrandt E, Peberdy M, Savitz L, Young L, Harvey M, Galhotra S (2006) Findings of the first consensus conference on medical emergency teams. Crit Care Med 34:2463–2478PubMedCrossRefGoogle Scholar
- 12.Lim SY, Park SY, Park HK, Kim M, Park HY, Lee B, Lee JH, Jung EJ, Jeon K, Park CM, Ko MG, Park MR, Nam JM, Won SY, Jung JH, Cho SH, Suh GY (2010) Early impact of medical emergency team implementation in a country with limited medical resources: a before-and-after study. J Crit Care 26(4):373–378PubMedCrossRefGoogle Scholar
- 16.Benoit DD, Depuydt PO, Vandewoude KH, Offner FC, Boterberg T, De Cock CA, Noens LA, Janssens AM, Decruyenaere JM (2006) Outcome in severely ill patients with hematological malignancies who received intravenous chemotherapy in the intensive care unit. Intensive Care Med 32:93–99PubMedCrossRefGoogle Scholar
- 17.Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, Campos RA, Iapichino G, Edbrooke D, Capuzzo M, Le Gall JR (2005) 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 31:1345–1355PubMedCrossRefGoogle Scholar
- 18.Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 22:707–710PubMedCrossRefGoogle Scholar
- 28.McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M (2007) Outreach and early warning systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 18(3):CD005529Google Scholar
- 35.Vandijck DM, Benoit DD, Depuydt PO, Offner FC, Blot SI, Van Tilborgh AK, Nollet J, Steel E, Noens LA, Decruyenaere JM (2008) Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med 34:847–855PubMedCrossRefGoogle Scholar