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Intensive Care Medicine

, Volume 45, Issue 7, pp 977–987 | Cite as

Changes in critically ill cancer patients’ short-term outcome over the last decades: results of systematic review with meta-analysis on individual data

  • Michaël DarmonEmail author
  • Aurélie Bourmaud
  • Quentin Georges
  • Marcio Soares
  • Kyeongman Jeon
  • Sandra Oeyen
  • Chin Kook Rhee
  • Pascale Gruber
  • Marlies Ostermann
  • Quentin A. Hill
  • Pieter Depuydt
  • Christelle Ferra
  • Anne-Claire Toffart
  • Peter Schellongowski
  • Alice Müller
  • Virginie Lemiale
  • Djamel Mokart
  • Elie Azoulay
Systematic Review

Abstract

Purpose

The number of averted deaths due to therapeutic advances in oncology and hematology is substantial and increasing. Survival of critically ill cancer patients has also improved during the last 2 decades. However, these data stem predominantly from unadjusted analyses. The aim of this study was to assess the impact of ICU admission year on short-term survival of critically ill cancer patients, with special attention on those with neutropenia.

Methods

Systematic review and meta-analysis of individual data according to the guidelines of meta-analysis of observational studies in epidemiology.

Datasource

Pubmed and Cochrane databases.

Eligibility criteria

Adult studies published in English between May 2005 and May 2015.

Results

Overall, 7354 patients were included among whom 1666 presented with neutropenia at ICU admission. Median ICU admission year was 2007 (IQR 2004–2010; range 1994–2012) and median number of admissions per year was 693 (IQR 450–1007). Overall mortality was 47.7%. ICU admission year was associated with a progressive decrease in hospital mortality (OR per year 0.94; 95% CI 0.93–0.95). After adjustment for confounders, year of ICU admission was independently associated with hospital mortality (OR for hospital mortality per year: 0.96; 95% CI 0.95–0.97). The association was also seen in patients with neutropenia but not in allogeneic stem cell transplant recipients.

Conclusion

After adjustment for patient characteristics, severity of illness and clustering, hospital mortality decreased steadily over time in critically ill oncology and hematology patients except for allogeneic stem cell transplant recipients.

Keywords

Prognosis Outcomes Hematologic neoplasms Intensive care units Mechanical ventilation Neutropenia 

Abbreviations

DFLST

Decision to forgo life-sustaining therapy

ICU

Intensive care unit

HSCT

Hematopoietic stem cell transplant

OR

Odds ratio

RRT

Renal replacement therapy

IQR

Interquartile range

95% CI

95% Confidence interval

APACHE

Acute physiology and chronic health evaluation

SAPS

Simplified acute physiology score

Notes

Acknowledgements

The authors thank Sophie Perinel and Marie Bouteloup for their invaluable help with this study.

Author contributions

MD conceived the study, participated in study design and coordination, acquisition of data, statistical analysis and interpretation of data, drafting of the manuscript and critical revision of the manuscript. AB participated in statistical analysis, interpretation of data, drafting of the manuscript and critical revision of the manuscript. QG participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. MS participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. KJ participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. SO participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. CKR participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. PG participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. MO participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. QAH participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. PD participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. CF participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. ACT participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. PS participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. AM participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. VL participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. FT participated in statistical analysis, interpretation of data, drafting of the manuscript and critical revision of the manuscript. DM participated in study design, interpretation of data, and critical revision of the manuscript. EA participated in acquisition of data, interpretation of data, drafting of the manuscript and critical revision of the manuscript. All authors read and approved the final manuscript. MD affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as registered have been explained. MD had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

None.

Compliance with ethical standards

Conflicts of interest

Dr. Darmon report having received consulting fees from Sanofi and Gilead-Kite, research support from Astute Medical and MSD, and speaker fees from MSD, Gilead-Kite and Astellas. Dr Ostermann received research support from Fresenius Medical and LaJolla Pharma. Dr. Azoulay reports grants, personal fees and other from Gilead-Kite, personal fees from Baxter, personal fees and other from Alexion, grants from MSD, grants from Ablynx, non-financial support from Fisher & payckle, outside the submitted work. Other authors report no conflict of interest related to this study.

Supplementary material

134_2019_5653_MOESM1_ESM.doc (336 kb)
Supplementary material 1 (DOC 335 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Michaël Darmon
    • 1
    • 2
    • 3
    Email author
  • Aurélie Bourmaud
    • 2
    • 4
    • 5
  • Quentin Georges
    • 6
  • Marcio Soares
    • 7
  • Kyeongman Jeon
    • 8
  • Sandra Oeyen
    • 9
  • Chin Kook Rhee
    • 10
  • Pascale Gruber
    • 11
  • Marlies Ostermann
    • 12
  • Quentin A. Hill
    • 13
  • Pieter Depuydt
    • 9
  • Christelle Ferra
    • 14
  • Anne-Claire Toffart
    • 15
  • Peter Schellongowski
    • 16
  • Alice Müller
    • 17
  • Virginie Lemiale
    • 1
  • Djamel Mokart
    • 18
  • Elie Azoulay
    • 1
    • 2
    • 3
  1. 1.Medical ICU, Saint-Louis University Hospital, AP-HPParisFrance
  2. 2.Faculté de MédecineUniversité Paris-Diderot, Sorbonne-Paris-CitéParisFrance
  3. 3.ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERMParisFrance
  4. 4.Public Health DepartmentRobert Debré University Hospital, AP-HPParisFrance
  5. 5.UMRS 1123, Clinical Epidemiology and Economic Evaluation Applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot UniversityParisFrance
  6. 6.Medical-Surgical ICUSaint-Etienne University HospitalSaint-ÉtienneFrance
  7. 7.Department of Critical Care and Graduate Program in Translational MedicineD’Or Institute for Research and EducationRio de JaneiroBrazil
  8. 8.Department of Critical Care Medicine, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  9. 9.Department of Intensive Care MedicineGhent University HospitalGhentBelgium
  10. 10.Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineThe Catholic University of KoreaSeoulSouth Korea
  11. 11.Department of Critical CareThe Royal Marsden HospitalLondonUK
  12. 12.Department of Critical Care and NephrologyKing’s College London, Guy’s and St Thomas’ NHS Foundation HospitalLondonUK
  13. 13.Department of HaematologyLeeds Teaching HospitalsLeedsUK
  14. 14.Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research InstituteUniversitat Autònoma de BarcelonaBadalonaSpain
  15. 15.Thoracic Oncology UnitGrenoble Alpes University HospitalGrenobleFrance
  16. 16.Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer CenterMedical University of ViennaViennaAustria
  17. 17.Universidade Federal do Rio Grande do Sul, Rio Grande do SulPorto AlegreBrazil
  18. 18.Anesthesiology and Intensive Care UnitInstitut Paoli CalmetteMarseilleFrance

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