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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

Intensive Care Medicine volume 45, pages 977–987 (2019)Cite this article

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.

Funding

None.

Author information

Authors and Affiliations

  1. Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France

    Michaël Darmon, Virginie Lemiale & Elie Azoulay

  2. Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France

    Michaël Darmon, Aurélie Bourmaud & Elie Azoulay

  3. ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris, France

    Michaël Darmon & Elie Azoulay

  4. Public Health Department, Robert Debré University Hospital, AP-HP, Paris, France

    Aurélie Bourmaud

  5. UMRS 1123, Clinical Epidemiology and Economic Evaluation Applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France

    Aurélie Bourmaud

  6. Medical-Surgical ICU, Saint-Etienne University Hospital, Saint-Étienne, France

    Quentin Georges

  7. Department of Critical Care and Graduate Program in Translational Medicine, D’Or Institute for Research and Education, Rio de Janeiro, Brazil

    Marcio Soares

  8. Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Kyeongman Jeon

  9. Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium

    Sandra Oeyen & Pieter Depuydt

  10. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea

    Chin Kook Rhee

  11. Department of Critical Care, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK

    Pascale Gruber

  12. Department of Critical Care and Nephrology, King’s College London, Guy’s and St Thomas’ NHS Foundation Hospital, London, UK

    Marlies Ostermann

  13. Department of Haematology, Leeds Teaching Hospitals, Leeds, UK

    Quentin A. Hill

  14. Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain

    Christelle Ferra

  15. Thoracic Oncology Unit, Grenoble Alpes University Hospital, Grenoble, France

    Anne-Claire Toffart

  16. Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Peter Schellongowski

  17. Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil

    Alice Müller

  18. Anesthesiology and Intensive Care Unit, Institut Paoli Calmette, Marseille, France

    Djamel Mokart

Authors
  1. Michaël Darmon
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  2. Aurélie Bourmaud
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  3. Quentin Georges
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  15. Alice Müller
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  16. Virginie Lemiale
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  18. Elie Azoulay
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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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  • DOI: https://doi.org/10.1007/s00134-019-05653-7

Keywords

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