title: Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency.
abstract: BACKGROUND
  This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.
  
  
  METHODS
  The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed. The data of 321 patients with no acute respiratory insufficiency as controls were also collected. Clinical variables of the first 24 hours after admission to intensive care unit were collected, including age, sex, comorbid disease, type of surgery, admission type, presence of shock, presence of acute kidney injury, presence of acute lung injury/acute respiratory distress syndrome, acute physiologic and chronic health evaluation (APACHE II) score, sepsis-related organ failure assessment (SOFA), and PaO2/FiO2 ratio. Duration of mechanical ventilation, length of intensive care unit stay, intensive care unit death, length of hospitalization, hospital death and one-year survival were calculated.
  
  
  RESULTS
  The incidence of acute respiratory insufficiency was 37.2% (190/321). Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases (P=0.001), surgery-related infection (P=0.004), hypo-volemic shock (P<0.001), and emergency surgery (P=0.018), were independent risk factors of postoperative acute respiratory insufficiency. Compared with the patients without acute respiratory insufficiency, the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay (P<0.001), a prolonged length of hospitalization (P=0.006), increased intensive care unit mortality (P=0.001), and hospital mortality (P<0.001). Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency (P=0.029, RR: 8.522, 95%CI: 1.243-58.437, B=2.143, SE=0.982, Wald=4.758). Compared with the patients without acute respiratory insufficiency, those with acute respiratory insufficiency had a shortened one-year survival rate (78.7% vs. 97.1%, P<0.001).
  
  
  CONCLUSIONS
  A history of chronic obstructive pulmonary diseases, surgery-related infection, hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency. Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency. Compared with patients without acute respiratory insufficiency, those with acute respiratory insufficiency had adverse short-term outcome and a decreased one-year survival rate.
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Xue-Zhong
authors.initials: XZ
authors.lastname: Xing
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Hai-Jun
authors.initials: HJ
authors.lastname: Wang
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Quan-Hui
authors.initials: QH
authors.lastname: Yang
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Chu-Lin
authors.initials: CL
authors.lastname: Huang
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Shi-Ning
authors.initials: SN
authors.lastname: Qu
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Qing-Ling
authors.initials: QL
authors.lastname: Xiao
authors.affiliation: Department of Intensive Care Unit, Cancer Hospital (Institute), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Ke-Lin
authors.initials: KL
authors.lastname: Sun
keywords: Acute respiratory insufficiency; Chronic obstructive pulmonary disease; Critical illness; Postoperative care; Prognosis; Risk factors; Septic shock; Survival