title: Predictors of survival in patients with sarcoma admitted to the intensive care unit.
abstract: BACKGROUND
  Advances in treatment of sarcoma patients has prolonged survival but has led to increased disease- or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU). Survival and long-term outcome information about such critically ill patients with sarcoma is unknown.
  
  
  METHODS
  The primary objective of the study was to determine the ICU and post-ICU survival rates of critically ill sarcoma patients. Secondary objectives included determining the modifiable and non-modifiable predictors of poor survival. We performed a retrospective chart review of sarcoma patients admitted to the ICU at The University of Texas MD Anderson Cancer Center between January 1, 2005, and December 31, 2012. Main outcome measures were ICU mortality, in-hospital mortality and 1, 2, and 6-month survival rates. Covariates such as histological diagnosis, disease characteristics, chemotherapy use, Charlson comorbidity index, Sequential Organ Failure Assessment (SOFA) scores, and clinical findings leading to ICU admission were analyzed for their effects on survival.
  
  
  RESULTS
  We identified 172 admissions over the 8-year study period hat met our inclusion criteria. The study population was 45.9 % males with a median age of 52 years. The most common sarcoma subgroups were high-grade unclassified sarcoma (25 %) and bone tumors (17.4 %). The ICU mortality rate was 23.3 % (95 % confidence interval [CI], 16.9-29.6 %), and an additional 6.4 % of patients died before hospital discharge (95 % CI, 22.9-37.1 %). 6-month OS rates were 41 %. The median SOFA scores on admission were 6 (inter quartile range (IQR), 3.5-9) in ICU survivors and 10 (IQR, 6.5-14) in ICU non-survivors. Increase in SOFA scores ≥6 led to poor outcomes (ICU survival 13.3 %, OS 6.7 %). Charlson comorbidity index (HR 1.139, 95 % CI 1.023-1.268, p = 0.02) and discharge SOFA scores (HR 1.210, 95 % CI 1.141-1.283, p < 0.0001) correlated with overall survival.
  
  
  CONCLUSIONS
  Our results suggest that patients that are admitted to the ICU for respiratory failure, cardiac arrest, septic shock, acute renal failure or acidosis and also have a high SOFA score with subsequent worsening in the ICU have poor prognosis. Based on the retrospective data which needs further validation we can recommend that judicious approach should be taken in patients with predictors of poor survival before subjecting them to aggressive treatment.
authors.affiliation: The University of Texas at Houston Internal Medicine Residency Program, Houston, TX USA.
authors.forename: Rohan
authors.initials: R
authors.lastname: Gupta
authors.affiliation: The University of Texas at Houston Internal Medicine Residency Program, Houston, TX USA.
authors.forename: Neda
authors.initials: N
authors.lastname: Heshami
authors.affiliation: The University of Texas at Houston Internal Medicine Residency Program, Houston, TX USA.
authors.forename: Chouhan
authors.initials: C
authors.lastname: Jay
authors.affiliation: The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX USA.
authors.forename: Naveen
authors.initials: N
authors.lastname: Ramesh
authors.affiliation: Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX USA.
authors.forename: Juhee
authors.initials: J
authors.lastname: Song
authors.affiliation: Division of Quantitative Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX USA.
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.affiliation: Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX USA.
authors.forename: Erfe Jean
authors.initials: EJ
authors.lastname: Rose
authors.affiliation: Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Carter
authors.affiliation: Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA.
authors.forename: Dejka M
authors.initials: DM
authors.lastname: Araujo
authors.affiliation: Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Benjamin
authors.affiliation: Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA.
authors.forename: Shreyaskumar
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Nates
authors.affiliation: Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd # 450, Houston, TX 77030 USA.
authors.forename: Vinod
authors.initials: V
authors.lastname: Ravi
keywords: Cancer; ICU; SOFA; Sarcoma; Survival