title: Prognostic factors in critically ill cancer patients admitted to the intensive care unit.
abstract: OBJECTIVE
  The objective of this study is to identify factors predicting intensive care unit (ICU) mortality in cancer patients admitted to a medical ICU.
  
  
  METHODS
  We conducted a retrospective study in 162 consecutive cancer patients admitted to the medical ICU of a 1000-bed university hospital between January 2009 and June 2012. Medical history, physical and laboratory findings on admission, and therapeutic interventions during ICU stay were recorded. The study end point was ICU mortality. Logistic regression analysis was performed to identify independent risk factors for ICU mortality.
  
  
  RESULTS
  The study cohort consisted of 104 (64.2%) patients with solid tumors and 58 patients (35.8%) with hematological malignancies. The major causes of ICU admission were sepsis/septic shock (66.7%) and respiratory failure (63.6%), respectively. Overall ICU mortality rate was 55 % (n=89). The ICU mortality rates were similar in patients with hematological malignancies and solid tumors (57% vs 53.8%; P=.744). Four variables were independent predictors for ICU mortality in cancer patients: the remission status of the underlying cancer on ICU admission (odds ratio [OR], 0.113; 95% confidence interval [CI], 0.027-0.48; P=.003), Acute Physiology and Chronic Health Evaluation II score (OR, 1.12; 95% CI, 1.032-1.215; P=.007), sepsis/septic shock during ICU stay (OR, 8.94; 95% CI, 2.28-35; P=.002), and vasopressor requirement (OR 16.84; 95% CI, 3.98-71.24; P=.0001). Although Acute Physiology and Chronic Health Evaluation II score (OR, 1.30; 95% CI, 1.054-1.61; P=.014), admission through emergency service (OR, 0.005; 95% CI, 0.00-0.69; P=.035), and vasopressor requirement during ICU stay (OR, 140.64; 95% CI, 3.59-5505.5; P=.008) were independent predictors for ICU mortality in patients with hematological malignancies, Sequential Organ Failure Assessment score (OR, 1.83; 95% CI, 1.29-2.6; P=.001), lactate dehydrogenase level on admission (OR, 1.002; 95% CI, 1-1.005; P=.028), sepsis/septic shock during ICU stay (OR, 138.4; 95% CI, 12.54-1528.4; P=.0001), and complete or partial remission of the underlying cancer (OR, 0.026; 95% CI, 0.002-0.3; P=.004) were the independent risk factors in patients with solid tumors.
  
  
  CONCLUSIONS
  Intensive care unit mortality rate was 55% in our cancer patients, which suggests that patients with cancer can benefit from ICU admission. We also found that ICU mortality rates of patients with hematological malignancies and solid tumors were similar.
authors.affiliation: Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Critical Care Medicine, Ankara, Turkey. Electronic address: aygencel@hotmail.com.
authors.forename: Gulbin
authors.initials: G
authors.lastname: Aygencel
authors.affiliation: Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Critical Care Medicine, Ankara, Turkey. Electronic address: meldaturkoglu@yahoo.com.tr.
authors.forename: Melda
authors.initials: M
authors.lastname: Turkoglu
authors.affiliation: Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey. Electronic address: aysucak@gazi.edu.tr.
authors.forename: Gulsan
authors.initials: G
authors.lastname: Turkoz Sucak
authors.affiliation: Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Medical Oncology, Ankara, Turkey. Electronic address: mbenekli@gmail.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Benekli
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000401:mortality; D005260:Female; D019337:Hematologic Neoplasms / Q000097:blood / Q000401:mortality; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000401:mortality*; D011379:Prognosis; D012074:Remission Induction; D012131:Respiratory Insufficiency; D012189:Retrospective Studies; D012307:Risk Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D007770:L-Lactate Dehydrogenase
keywords: ICU mortality; cancer patient; prognostic factor