title: Effect of Early Intervention on Long-Term Outcomes of Critically Ill Cancer Patients Admitted to ICUs.
abstract: OBJECTIVE
  The objective of this observational study was to evaluate whether early intervention was associated with improved long-term outcomes in critically ill patients with cancer.
  
  
  METHODS
  Retrospective analysis with prospectively collected data.
  
  
  METHODS
  A university-affiliated, tertiary referral hospital.
  
  
  METHODS
  Consecutive critically ill cancer patients who were managed by a medical emergency team before ICU admission between January 2010 and December 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  During the study period, 525 critically ill cancer patients were admitted to the ICU with respiratory failure (41.7%) and severe sepsis or septic shock (40.6%) following medical intervention by a medical emergency team. Of 356 ICU survivors, 161 (45.2%) received additional treatment for cancer after ICU discharge. Mortality was 66.1% at 6 months and 72.8% at 1 year. Median time from physiological derangement to intervention before ICU admission was significantly shorter in 1-year survivors (1.3 hr; interquartile range, 0.5-4.8 hr) than it was in nonsurvivors (2.9 hr; interquartile range, 0.8-9.6 hr) (p< 0.001). Additionally, the early intervention (≤ 1.5 hr) group had a lower 30-day mortality rate than the late intervention (> 1.5 hr) group (29.0% vs 55.3%; p < 0.001) and a similar difference in mortality rate was observed up to 1 year. Other factors associated with 1-year mortality were illness severity, performance status, malignancy status, presence of more than three abnormal physiological variables, time from derangement to ICU admission, and the need for mechanical ventilation. Even after adjusting for potential confounding factors, early intervention was significantly associated with 1-year mortality (adjusted hazard ratio, 0.456; 95% CI, 0.348-0.597; p < 0.001).
  
  
  CONCLUSIONS
  Early intervention for clinical derangement on general wards was significantly associated with long-term outcomes in critically ill cancer patients.
authors: 1Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 3Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 4Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Dae-Sang
authors: DS
authors: Lee
authors: Gee Young
authors: GY
authors: Suh
authors: Jeong-Am
authors: JA
authors: Ryu
authors: Chi Ryang
authors: CR
authors: Chung
authors: Jeong Hoon
authors: JH
authors: Yang
authors: Chi-Min
authors: CM
authors: Park
authors: Kyeongman
authors: K
authors: Jeon
mesh_terms: D000368:Aged; D003422:Critical Care; D016638:Critical Illness; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome