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

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.

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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

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Acknowledgements

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

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Authors

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.

Corresponding author

Correspondence to Michaël Darmon.

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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.

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Darmon, M., Bourmaud, A., Georges, Q. et al. Changes in critically ill cancer patients’ short-term outcome over the last decades: results of systematic review with meta-analysis on individual data. Intensive Care Med 45, 977–987 (2019). https://doi.org/10.1007/s00134-019-05653-7

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Keywords

  • Prognosis
  • Outcomes
  • Hematologic neoplasms
  • Intensive care units
  • Mechanical ventilation
  • Neutropenia