Risk factors to predict outcome in critically ill cancer patients receiving chemotherapy in the intensive care unit.
OBJECTIVE
The decision to start chemotherapy in critically ill cancer patients is extremely complex in the intensive care unit (ICU). Therefore, this study evaluated the outcomes and prognostic factors in critically ill cancer patients receiving chemotherapy in the ICU.


METHODS
A retrospective analysis was performed using 62 cancer patients who received chemotherapy in the ICU between October 2002 and December 2008. The dataset included 49 hematologic malignancies (79%) and 13 solid tumors (21%).


RESULTS
Twenty (32%) patients were admitted to the ICU with septic shock, 15 (24%) with respiratory failure, and 14 (23%) with renal failure. The median SOFA and SAPS II scores at the time of chemotherapy were 10 (interquartile range, 6-14) and 53 (interquartile range, 41-68), respectively. Twenty-three (37%) patients had concomitant infections when chemotherapy was initiated. Thirty-eight (61%) patients received mechanical ventilation, and 19 (31%) patients underwent renal replacement therapy at the moment of chemotherapy. Overall, 25 (40%) patients died in the ICU; death occurred due to septic shock (13, 52%), cancer progression (9, 36%), or bleeding (2, 8%). ICU mortality after chemotherapy was correlated with respiratory failure requiring mechanical ventilation (OR, 6.26; 95% CI, 1.12-34.95) and a SOFA score of ≥10 (OR, 9.66; 95% CI, 1.43-65.47) upon initiating chemotherapy.


CONCLUSIONS
Chemotherapy in the ICU for critically ill cancer patients can be considered even when infection or organ failure is present. However, the severity of organ failure, including respiratory failure requiring mechanical ventilation, was associated with an increased mortality after chemotherapy during an ICU stay.
Song
Jae-Uk
JU
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Suh
Gee Young
GY
Chung
Man Pyo
MP
Kim
Hojoong
H
Kwon
O Jung
OJ
Jung
Chul Won
CW
Kang
Won Ki
WK
Park
Keunchil
K
Jeon
Kyeongman
K
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
D000970:Antineoplastic Agents