title: Thirty-day mortality in critical care outreach patients with cancer: an investigative study of predictive factors related to outreach referral episodes.
abstract: OBJECTIVE
  To establish factors that predict outcome in critically ill, deteriorating cancer patients through critical care outreach referral episodes, characteristics and care reviews.
  
  
  METHODS
  A population-based prospective and retrospective study was undertaken with analysis exploring predictive factors regarding critically ill cancer patients referred to a critical care outreach team. Data collected included: diagnosis; presenting problem; early warning scores at referral and at deterioration; physiological and observation data; admission to critical care, length of stay; 30-day mortality; limitation of care including precipitating DNAR orders and documentation of not for CCU admission/intervention).
  
  
  RESULTS
  Data were collected on 407 episodes from 318 patients over a period of 8 months from 2006 to 2007. Outreach initiated decisions to limit care with medical teams in 32.2% (n=103/318) of all patients. Early warning scores were not predictive of outcome. A high heart rate at referral (HR), a high potassium, low SpO2 at time of deterioration were independently predictive of 30-day mortality. The logistic regression (LR) model, using these three variables correctly predicts the 30-day outcome of 71% of the patients, demonstrating a relatively high predictability in this patient population. The odds of mortality increase with a higher potassium, heart rate and as the oxygen saturation at deterioration (DSpO(2)) worsen. Management factors included limitation of care, which is highly associated with 30-day mortality. Cancer patients recently receiving chemotherapy may have an increased mortality once admitted to critical care. Being a haemato-oncology patient, or the timeliness of critical care outreach referral does not appear to affect 30-day mortality.
  
  
  CONCLUSIONS
  The LR model was able to predict 30-day outcome of 71% of the patients, demonstrating a reasonably high predictability in this cancer patient population. Critical care outreach initiated discussions on limiting treatment which had an effect on mortality.
authors: CCU Outreach Office, The Royal Marsden NHS Foundation Trust, Downs Rd, Sutton, Surrey SM25PT, United Kingdom. nataliepattison@hotmail.com
authors: Natalie
authors: N
authors: Pattison
authors: Sue
authors: S
authors: Ashley
authors: Paul
authors: P
authors: Farquhar-Smith
authors: Lara
authors: L
authors: Roskelly
authors: Geraldine
authors: G
authors: O'Gara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003159:Community-Institutional Relations; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D006339:Heart Rate; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000628:therapy; D010100:Oxygen / Q000097:blood; D011188:Potassium / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation; D012189:Retrospective Studies; D006113:United Kingdom
chemical_list: D011188:Potassium; D010100:Oxygen