TY - JOUR
T1 - Survival and functional outcomes of patients with metastatic solid organ cancer admitted to the intensive care unit of a tertiary centre
AU - Ha, Francis J.
AU - Weickhardt, Andrew J.
AU - Parakh, Sagun
AU - Vincent, Andrew D.
AU - Glassford, Neil J.
AU - Warrillow, Stephen
AU - Jones, Daryl
PY - 2017
Y1 - 2017
N2 - Objective: Metastatic solid organ cancer is associated with a poor prognosis, and admission of patients with these cancers to the intensive care unit remains a dilemma. We aimed to assess outcomes in a cohort of these patients who were admitted to the ICU of a general tertiary centre. Design, setting and patients: A retrospective observational study of patients with incurable metastatic solid organ malignancies who had unplanned admission to a tertiary hospital ICU between 1 January 2010 and 30 June 2015. Main outcome measures: Survival outcomes up to 1 year after ICU admission, and functional outcomes as measured by Eastern Cooperative Oncology Group (ECOG) grade up to 3 months after ICU discharge. We also determined rates of advance care planning documentation. Results: A total of 101 patients were treated in the ICU during the study period. Hospital, 30-day and 1-year mortality rates were 35%, 41% and 77%, respectively, and the median survival was 2.3 months (95% CI, 1.1–3.9 months). On multivariable analysis, lowest albumin level (hazard ratio [HR], 1.10; 95% CI, 1.04–1.15) and highest white cell count (HR, 1.03; 95% CI, 1.00–1.07) were significant, although they were marginal predictors of poorer overall survival. Higher ECOG grade showed a trend towards significance (HR, 1.60; 95% CI, 0.94–2.73; P = 0.08). In patients alive and assessable at 1 month, 17/31 (55%) had functionally declined. At 3 months, 15/22 surviving patients (68%) had returned to their baseline, pre-ICU admission ECOG grade. Ninety per cent had no advance care directive and two-thirds did not have a medical enduring power of attorney. Conclusions: Survival is poor in patients with metastatic cancer after emergent ICU admission, although functional state is often recovered by 3 months in surviving patients. Albumin level, white cell count and ECOG grade are simple prognostic markers of survival.
AB - Objective: Metastatic solid organ cancer is associated with a poor prognosis, and admission of patients with these cancers to the intensive care unit remains a dilemma. We aimed to assess outcomes in a cohort of these patients who were admitted to the ICU of a general tertiary centre. Design, setting and patients: A retrospective observational study of patients with incurable metastatic solid organ malignancies who had unplanned admission to a tertiary hospital ICU between 1 January 2010 and 30 June 2015. Main outcome measures: Survival outcomes up to 1 year after ICU admission, and functional outcomes as measured by Eastern Cooperative Oncology Group (ECOG) grade up to 3 months after ICU discharge. We also determined rates of advance care planning documentation. Results: A total of 101 patients were treated in the ICU during the study period. Hospital, 30-day and 1-year mortality rates were 35%, 41% and 77%, respectively, and the median survival was 2.3 months (95% CI, 1.1–3.9 months). On multivariable analysis, lowest albumin level (hazard ratio [HR], 1.10; 95% CI, 1.04–1.15) and highest white cell count (HR, 1.03; 95% CI, 1.00–1.07) were significant, although they were marginal predictors of poorer overall survival. Higher ECOG grade showed a trend towards significance (HR, 1.60; 95% CI, 0.94–2.73; P = 0.08). In patients alive and assessable at 1 month, 17/31 (55%) had functionally declined. At 3 months, 15/22 surviving patients (68%) had returned to their baseline, pre-ICU admission ECOG grade. Ninety per cent had no advance care directive and two-thirds did not have a medical enduring power of attorney. Conclusions: Survival is poor in patients with metastatic cancer after emergent ICU admission, although functional state is often recovered by 3 months in surviving patients. Albumin level, white cell count and ECOG grade are simple prognostic markers of survival.
UR - http://www.scopus.com/inward/record.url?scp=85023777643&partnerID=8YFLogxK
M3 - Article
C2 - 28651512
AN - SCOPUS:85023777643
VL - 19
SP - 159
EP - 166
JO - Critical Care and Resuscitation
JF - Critical Care and Resuscitation
SN - 1441-2772
IS - 2
ER -