Outcomes of 1,000 patients with cancer admitted to the intensive care unit: a Brazilian prospective study

Introduction

ICU admission of critically ill cancer patients was controversial until recently. In the past years, advances in the management of malignancies and organ failures have improved outcomes of patients, resulting in higher rates of survival in the ICU. The aim of this study is to prospectively evaluate the characteristics, short-term and mid-term outcomes of cancer patients requiring intensive care.

Methods

During 1 year, we evaluated prospectively patients with cancer admitted to the Instituto do Cancer do Estado de São Paulo. A total of 1,000 patients were included in the study; and collected data were: baseline data, risk scores, clinical status, co-morbidities, admission diagnosis, ICU interventions, ICU and hospital outcomes and 90-day outcomes.

Results

From 1,000 patients, 828 (82.8%) had solid tumors and 172 (17.2%) had hematologic malignancies. The most frequent reasons for ICU admission were: sepsis (31%), postoperative care (29%) and respiratory failure (24%). The mean APACHE II score value at the day of admission was 24.1 ± 8.8 (8 to 45). ICU mortality was 24%, hospital mortality was 32% and 3-month mortality was 41%. Logistic regression analysis showed that need for mechanical ventilation (odds ratio = 6.76; 95% CI = 3.56 to 12.85), presence of metastasis (odds ratio = 3.87; 95% CI = 2.06 to 7.28), occurrence of acute renal failure (odds ratio = 3.92; 95% CI = 1.47 to 10.46) and higher SOFA scores 72 hours after admission (odds ratio = 5.76; 95% CI = 4.56 to 14.85) were independently associated with increased hospital mortality. Three-month quality of life of patients who survived was considered unchanged in 55% patients, worse in 25% and better in 20%.

Conclusions

This prospective analysis of 1,000 patients with cancer needing intensive care shows high survival rates and good quality of life after ICU admission. These data encourage intensive care treatment in oncologic patients to prevent, detect and cure organ dysfunction.