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Predictors of short-term mortality in critically ill patients with solid malignancies
E Azoulay1, D Moreau, C Alberti
1Medical Intensive Care Unit, Saint Louis Teaching Hospital and University Paris 7, France. elie.azoulay@sls.ap-hop-paris.fr
Intensive Care Medicine
|March 29, 2001
Summary
Predicting 30-day mortality in cancer patients admitted to the ICU is crucial. Acute organ dysfunction, not cancer characteristics, better estimates survival for critically ill cancer patients.
Area of Science:
- Critical Care Medicine
- Oncology
- Prognostic Factor Analysis
Background:
- Admission of cancer patients with serious medical complications to the ICU is controversial due to high mortality rates.
- The heterogeneity of cancer patients suggests variable intensive care effectiveness.
Purpose of the Study:
- To identify factors predicting 30-day mortality in patients with solid tumors admitted to a medical ICU.
Main Methods:
- Retrospective study of 120 consecutive cancer patients (excluding hematological malignancies) admitted to a medical ICU.
- Recorded medical history, physical and laboratory findings, and initial ICU interventions.
- Used stepwise logistic regression to identify independent prognostic factors for 30-day mortality.
Main Results:
- Observed 30-day mortality rate was 58.7%, with most deaths occurring in the ICU.
- Independent predictors of 30-day mortality included previous cancer surgery (protective), LOD score > 6, and need for mechanical ventilation.
- Factors like advanced age and metastatic disease were not predictive.
Conclusions:
- Acute organ dysfunction is a better predictor of 30-day mortality than underlying malignancy characteristics.
- ICU transfer decisions for cancer patients should consider organ dysfunction assessment.