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Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients

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Abstract

We aimed to evaluate the characteristics, resource use and outcomes of critically ill patients with cancer according to appropriateness of ICU admission. This was a retrospective cohort study of patients with cancer admitted to ICU from January 2017 to December 2018. Patients were classified as appropriate, potentially inappropriate, or inappropriate for ICU admission according to the Society of Critical Care Medicine guidelines. The primary outcome was ICU length of stay (LOS). Secondary outcomes were one-year, ICU, and hospital mortality, hospital LOS and utilization of ICU organ support. We used logistic regression and competing risk models accounting for relevant confounders in primary outcome analyses. From 6700 admitted patients, 5803 (86.6%) were classified as appropriate, 683 (10.2%) as potentially inappropriate and 214 (3.2%) as inappropriate for ICU admission. Potentially inappropriate and inappropriate ICU admissions had lower likelihood of being discharged from the ICU than patients with appropriate ICU admission (sHR 0.55, 95% CI 0.49–0.61 and sHR 0.65, 95% CI 0.53–0.81, respectively), and were associated with higher 1-year mortality (OR 6.39, 95% CI 5.60–7.29 and OR 11.12, 95% CI 8.33–14.83, respectively). Among patients with appropriate, potentially inappropriate, and inappropriate ICU admissions, ICU mortality was 4.8%, 32.6% and 35.0%, and in-hospital mortality was 12.2%, 71.6% and 81.3%, respectively (p < 0.01). Use of organ support was more common and longer among patients with potentially inappropriate ICU admission. The findings of our study suggest that inappropriateness for ICU admission among patients with cancer was associated with higher resource use in ICU and higher one-year mortality among ICU survivors.

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Availability of data and materials

The datasets used and analyzed in our study are available from the corresponding author upon reasonable request.

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Acknowledgements

PIBIC/CNPQ fellowships to Anna Karolyne A. Costa and Giovanna A. Gennari are gratefully acknowledged.

Funding

This study did not receive any funding.

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Authors and Affiliations

  1. Intensive Care Unit, A.C.Camargo Cancer Center, São Paulo, Brazil

    Carla Marchini Dias Silva, Pedro Caruso & Antonio Paulo Nassar Jr

  2. Intensive Care Unit, Hospital Vila Nova Star, São Paulo, Brazil

    Carla Marchini Dias Silva

  3. International Research Center, A.C.Camargo Cancer Center, São Paulo, Brazil

    Janaina Naiara Germano

  4. A.C.Camargo Cancer Center, São Paulo, Brazil

    Anna Karolyne de Araujo Costa & Giovanna Alves Gennari

  5. Residency Program Hospital Israelita Albert Einstein, São Paulo, Brazil

    Anna Karolyne de Araujo Costa

  6. Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil

    Giovanna Alves Gennari

  7. Pulmonary Division, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Pedro Caruso

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Contributions

CMDS: study concept and design; data acquisition; statistical analysis and interpretation of data; drafting of the first manuscript. APNJ: study concept and design; statistical analysis and interpretation of data; critical revision of the manuscript. JNG: statistical analysis and interpretation of data. AKAC and GAG: data acquisition. PC: critical revision of the manuscript for important intellectual content. All the authors have read and approved the final manuscript.

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Correspondence to Carla Marchini Dias Silva.

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Competing interests

The author APNJ has received financial support from the Brazilian National Council for Scientific Development (CNPq).

Ethics approval and consent to participate

The Ethics Committee for Scientific Research of the A.C. Camargo Cancer Center (Institutional Review Board -IRB) approved the study and waived the need for informed consent (CAAE: 05694819.3.0000.5432, approval date 03/11/2019). We followed the ethical standards of the regional committee on human experimentation and with the Helsinki Declaration of 1975.

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Antonio Paulo Nassar Jr has received financial support from the Brazilian National Council for Scientific Development (CNPq).

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Silva, C.M.D., Germano, J.N., Costa, A.K.d. et al. Association of appropriateness for ICU admission with resource use, organ support and long-term survival in critically ill cancer patients. Intern Emerg Med 18, 1191–1201 (2023). https://doi.org/10.1007/s11739-023-03216-9

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