Outcomes in critically ill patients with cancer-related complications

Introduction

Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment, and therefore usually require admission to ICUs.

Objective

To evaluate the clinical characteristics and outcomes in this subgroup of patients.

Methods

Analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality.

Results

Out of 2028 patients, 456 (23 %) had cancer-related complications. Compared with those without complications, they more frequently had worse performance status (PS) (57 % vs. 36 % with PS ≥2), active malignancy (43 % vs. 5 %), need for vasopressors (45 % vs. 34 %), mechanical ventilation (70 % vs. 51 %) and dialysis (12 % vs. 8 %) (P <0.001 for all analyses). ICU (47 % vs. 27 %) and hospital (63 % vs. 38 %) mortality rates were also higher in patients with complications (P <0.001). Chemo/radiation therapy-induced toxicity (6 %), venous thromboembolism (5 %), respiratory failure (4 %), gastrointestinal involvement (3 %) and vena cava syndrome (VCS) (2 %) were the most frequent complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality (odds ratio (OR) = 1.25 (95 % confidence interval, 0.94-1.66)). However, among the individual complications, VCS (OR = 3.79 (1.11-12.92)), gastrointestinal involvement (OR = 3.05 (1.57-5.91)) and respiratory failure (OR = 1.96 (1.04-3.71)) were independently associated with worse outcomes.

Conclusion

The prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of a severe acute cancer-related complication per se should not guide decisions to admit a patient to the ICU.