title: Life-threatening complications and outcomes in patients with malignancies and severe pulmonary embolism.
abstract: BACKGROUND
  Data are scarce about ICU patients with malignancy and severe pulmonary embolism. Here, our main objective was to identify risk factors for life-threatening complications, organ failures, and death in ICU patients with severe pulmonary embolism, with special attention to the impact of malignancy. We also described the clinical features of PE in patients with and without malignancies.
  
  
  METHODS
  Data from consecutive adults admitted to our ICU in 2002-2011 with severe pulmonary embolism were collected retrospectively. Multivariate analysis was performed to look for factors associated with death, organ failures, or life-threatening complications (major bleeding, recurrent PE, and cardiac arrest).
  
  
  RESULTS
  Of 119 included patients (42 [35%] with bilateral pulmonary embolism), 41 had solid malignancies, 27 hematological malignancies, and 51 no malignancies. The most common symptoms were syncope (40%) and hemoptysis (18%) in patients with solid and hematological malignancies, respectively. Life-threatening complications occurred in 23 (19%) patients; risk factors were obesity (OR, 13.22; 1.93-90.70), disseminated intravascular coagulation/ischemic hepatitis (OR, 27.06; 5.14-142.46), fluid load ≥1000 mL/24 h (OR, 6.42; 1.60-25.76), and solid malignancy (OR, 5.45; 1.15-25.89). Inhospital mortality was 27/119 (23%) and respiratory or circulatory failure developed in 36 (30%) patients. Risk factors for these adverse outcomes were older age (OR, 1.04/year; 1.01-1.07), higher oxygen flow rate (OR, 1.28/L; 1.13-1.45); and renal failure (OR, 8.08; 2.50-26.11); whereas chest pain was protective (OR, 0.13; 0.04-0.48).
  
  
  CONCLUSIONS
  In this study, solid malignancy was a risk factor for life-threatening complications but not for death.
authors.affiliation: ICU, Saint Louis Teaching Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France. Electronic address: sandrine.valade@sls.aphp.fr.
authors.forename: S
authors.initials: S
authors.lastname: Valade
authors.affiliation: ICU, Saint Louis Teaching Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: Lemiale
authors.affiliation: Respiratory care unit, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Roux
authors.affiliation: ICU, Saint Louis Teaching Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Schnell
authors.affiliation: ICU, Saint Louis Teaching Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Mariotte
authors.affiliation: ICU, Saint Louis Teaching Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Reuter
authors.affiliation: ICU, Saint Louis Teaching Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Canet
authors.affiliation: ICU, Saint Louis Teaching Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Schlemmer
authors.affiliation: ICU, Saint Louis Teaching Hospital, 1 avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Death; ICU; Malignancy; Organ failures; Pulmonary embolism