Central neurological complications in critically ill patients with malignancies.
OBJECTIVE
To determine outcomes in critically ill patients hospitalized in the ICU for central neurological complications of cancer.


METHODS
A 7-year retrospective study. SUBJECT AND INTERVENTION: Observational study in 100 critically ill cancer patients with central neurological complications managed using standardized diagnostic and therapeutic strategies.


RESULTS
There were 52 men and 48 women, aged 55 years (IQR, 40-65). Presenting manifestations were coma (56%), epilepsy (48%), focal signs (35%), encephalopathy (31%), and meningitis (7%). Cerebral imaging was abnormal in 61 patients, lumbar puncture in 17, and electroencephalography in 6. Neurosurgical biopsy was performed on four patients. The main etiologies included drug toxicity in 28, malignant brain infiltration in 21 patients, and cerebrovascular disease in 20. Mechanical ventilation was needed for 60 patients. Anticancer chemotherapy was administered during the ICU stay in 15 patients. ICU and hospital mortalities were 28 and 45%, respectively. By multivariate analysis, independent positive predictors of hospital mortality were poor performance status [odds ratio (OR) 2.94, 95% CI, 1.01-8.55, P = 0.047), focal signs at presentation (OR 3.52, 95% CI, 1.14-10.88, P = 0.029), abnormal lumbar puncture (OR 5.49, 95% CI 1.09-27.66, P = 0.038), and need for vasoactive drugs (OR 6.47, 95% CI 1.32-31.66, P = 0.021), whereas remission of the malignancy (OR 0.20, 95% CI 0.04-0.88, P = 0.033) and GCS score at admission (OR 0.81/point, 95% CI, 0.70-0.95, P = 0.009) were negative predictors of hospital mortality.


CONCLUSIONS
In cancer patients, central neurological events are mainly related to malignant brain infiltration and drug-related toxicity. Despite advanced severity, a standardized intensive management strategy yields a 55% hospital survival rate.
Legriel
Stéphane
S
Medical Intensive Care Unit, AP-HP, Hôpital Saint-Louis, 75010 Paris, France. stlegriel@invivo.edu
Marijon
Hélène
H
Darmon
Michael
M
Lemiale
Virginie
V
Bedos
Jean-Pierre
JP
Schlemmer
Benoît
B
Azoulay
Elie
E
D000328:Adult; D000368:Aged; D003128:Coma / Q000175:diagnosis / Q000453:epidemiology*; D016638:Critical Illness; D004569:Electroencephalography; D005260:Female; D006760:Hospitalization; D006801:Humans; D002534:Hypoxia, Brain / Q000175:diagnosis / Q000453:epidemiology*; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008581:Meningitis / Q000453:epidemiology*; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000534:rehabilitation*; D012121:Respiration, Artificial; D013129:Spinal Puncture