Acute neurological dysfunction in critically ill patients with solid tumors: A 14-year retrospective study

Area of Science:

• Oncology
• Neurology
• Intensive Care Medicine

Background:

• Cancer therapies improve survival, increasing the number of oncology patients in intensive care units (ICUs).
• Acute neurological dysfunction (ND) is a significant concern in critically ill cancer patients, yet it is understudied compared to respiratory and hemodynamic failures.

Purpose of the Study:

• To investigate the characteristics and outcomes of solid tumor patients admitted to the ICU specifically for acute ND.
• To categorize the causes of ND into cancer-related, treatment-related, and non-specific.

Main Methods:

• A single-center retrospective study was conducted from 2007 to 2020.
• Data from 1845 solid tumor patients admitted to the ICU were analyzed, focusing on 164 patients presenting with acute ND.

Main Results:

• Acute ND occurred in 8.9% of solid tumor ICU admissions, with seizures, coma, and delirium as primary causes.
• Cancer-related ND (36%) and independent complications (56%) were the most common etiologies, while treatment-related ND accounted for 8%.
• ICU mortality was 18%, with coma at admission being the sole significant predictor of mortality.

Conclusions:

• Approximately 10% of ICU admissions for solid tumors involve acute ND.
• Cancer-related ND is characterized by rapid symptom onset and neurological deficits like coma or motor impairment.
• Acute neurological dysfunction, even when cancer-related, did not adversely affect ICU survival in this cohort.