title: Outcomes in Critically Ill Patients with Cancer-Related Complications.
abstract: BACKGROUND
  Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients.
  
  
  METHODS
  Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality.
  
  
  RESULTS
  Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P<0.001 for all analyses). ICU (47% vs. 27%) and hospital (63% vs. 38%) mortality rates were also higher in patients with cancer-related complications (P<0.001). Chemo/radiation therapy-induced toxicity (6%), venous thromboembolism (5%), respiratory failure (4%), gastrointestinal involvement (3%) and vena cava syndrome (VCS) (2%) were the most frequent cancer-related complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality [odds ratio (OR) = 1.25 (95% confidence interval, 0.94-1.66), P = 0.131]. However, among the individual cancer-related complications, VCS [OR = 3.79 (1.11-12.92), P = 0.033], gastrointestinal involvement [OR = 3.05 (1.57-5.91), P = <0.001] and respiratory failure [OR = 1.96(1.04-3.71), P = 0.038] were independently associated with in-hospital mortality.
  
  
  CONCLUSIONS
  The prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of an acute cancer-related complication per se should not guide decisions to admit a patient to ICU.
authors.affiliation: Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Viviane B L
authors.initials: VB
authors.lastname: Torres
authors.affiliation: Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Vassalo
authors.affiliation: ICU, Fundação Pio XII, Hospital do Câncer de Barretos, Barretos, Brazil.
authors.forename: Ulysses V A
authors.initials: UV
authors.lastname: Silva
authors.affiliation: ICU, A.C. Camargo Cancer Center, São Paulo, Brazil.
authors.forename: Pedro
authors.initials: P
authors.lastname: Caruso
authors.affiliation: Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI), Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
authors.forename: André P
authors.initials: AP
authors.lastname: Torelly
authors.affiliation: ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Eliezer
authors.initials: E
authors.lastname: Silva
authors.affiliation: ICU, Hospital Português, Salvador, Brazil.
authors.forename: José M M
authors.initials: JM
authors.lastname: Teles
authors.affiliation: Hospital São Lucas, Travessa Frederico Pamplona 32, Rio de Janeiro, Brazil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Knibel
authors.affiliation: ICU, Hospital do Servidor Público Estadual, São Paulo, Brazil.
authors.forename: Ederlon
authors.initials: E
authors.lastname: Rezende
authors.affiliation: ICU, Instituto Nacional de Câncer, Hospital do Câncer II, Rio de Janeiro, Brazil.
authors.forename: José J S
authors.initials: JJ
authors.lastname: Netto
authors.affiliation: ICU, Vitória Apart Hospital, Vitória, Brazil.
authors.forename: Claudio
authors.initials: C
authors.lastname: Piras
authors.affiliation: Research and Education Institute, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: Luciano C P
authors.initials: LC
authors.lastname: Azevedo
authors.affiliation: IDOR, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.|National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Bozza
authors.affiliation: Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Spector
authors.affiliation: Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.|IDOR, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.|Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh
authors.affiliation: Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.|IDOR, D'Or Institute for Research and Education, Rio de Janeiro, Brazil.|Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Marcio
authors.initials: M
authors.lastname: Soares
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D016638:Critical Illness; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006402:Hematologic Diseases / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000150:complications; D054556:Venous Thromboembolism / Q000150:complications
chemical_list: D000970:Antineoplastic Agents