title: Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units.
abstract: OBJECTIVE
  To determine whether earlier intervention was associated with decreased mortality in critically ill cancer patients admitted to an intensive care unit (ICU).
  
  
  METHODS
  A retrospective observational study was performed of 199 critically ill cancer patients admitted to the ICU from the general ward between January 2010 and December 2010. A logistic regression model was used to adjust for potential confounding factors in the association between time to intervention and in-hospital mortality.
  
  
  RESULTS
  In-hospital mortality was 52 %, with a median Simplified Acute Physiology Score 3 (SAPS 3) of 80 [interquartile range (IQR) 67-93], and a median Sequential Organ Failure Assessment (SOFA) score of 8 (IQR 5-11). Median time from physiological derangement to intervention (time to intervention) prior to ICU admission was 1.5 (IQR 0.6-4.3) h. Median time to intervention was significantly shorter in survivors than in non-survivors (0.9 vs. 3.0 h; p < 0.001). Additionally, the mortality rates increased significantly with increasing quartiles of time to intervention (p < 0.001, test for trend). Other factors associated with in-hospital mortality were severity of illness, performance status, hematologic malignancy, stem-cell transplantation, presence of three or more abnormal physiological variables, time from derangement to ICU admission, presence of infection, need for mechanical ventilation and vasopressor, and low PaO(2)/FiO(2) ratio. Even after adjusting for potential confounding factors, time to intervention was still significantly associated with hospital mortality (adjusted odds ratio 1.445, 95 % confidence interval 1.217-1.717).
  
  
  CONCLUSIONS
  Early intervention before ICU admission was independently associated with decreased in-hospital mortality in critically ill cancer patients admitted to the ICU.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine,  Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.
authors.forename: Jae-Uk
authors.initials: JU
authors.lastname: Song
authors.forename: Gee Young
authors.initials: GY
authors.lastname: Suh
authors.forename: Hye Yun
authors.initials: HY
authors.lastname: Park
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Lim
authors.forename: Seo Goo
authors.initials: SG
authors.lastname: Han
authors.forename: Yeh Rim
authors.initials: YR
authors.lastname: Kang
authors.forename: O Jung
authors.initials: OJ
authors.lastname: Kwon
authors.forename: Sookyoung
authors.initials: S
authors.lastname: Woo
authors.forename: Kyeongman
authors.initials: K
authors.lastname: Jeon
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D016638:Critical Illness; D005260:Female; D006305:Health Status Indicators; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007723:Korea; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D016017:Odds Ratio; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome