title: Gastrointestinal emergencies in critically ill cancer patients.
abstract: To describe gastrointestinal emergencies in cancer patients.
  
  
  
  All cancer patients admitted to the medical ICU of Saint-Louis Hospital for an acute abdominal syndrome during the study period (1997-2011) were included.
  
  
  
  A total of 164 patients were included. The most common diagnoses were: neutropenic enterocolitis (NE) (n=54, 33%), infectious colitis and peritonitis (n=51, 31%), bowel infiltration by malignancy (n=14, 9%), and mucosal toxicity of chemotherapy (n=12, 7%). Microbiologically documented infections were reported in 82 patients (50%), including 12 fungal infections. Twenty-seven patients (16%) underwent urgent surgery. The hospital mortality rate was 35%. Five factors were independently associated with hospital mortality: the Simplified Acute Physiology Score II (SAPS II) score on day 1 (OR 1.03/SAPS II point, 95% CI 1.01 to 1.05), microbiological documentation (OR 0.27, 95% CI 0.11 to 0.64), neutropenia (OR 0.42, 95% CI 0.19 to 0.95), allogenic hematopoietic stem-cell transplantation (HSCT) (OR 5.13, 95% CI 1.71 to 15.4), and mechanical ventilation (OR 3.42, 95% CI 1.37 to 8.51).
  
  
  
  Gastrointestinal emergencies in cancer patients are associated with significant mortality. Mortality correlated both with the severity of organ failure upon ICU admission and the underlying diagnosis. Interestingly, patients admitted to the ICU with neutropenia had better survival.
authors.affiliation: Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Lebon
authors.affiliation: Biostatistics Department, Saint-Louis University Hospital, AP-HP, Paris, France.
authors.forename: Lucie
authors.initials: L
authors.lastname: Biard
authors.affiliation: Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Buyse
authors.affiliation: Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Schnell
authors.affiliation: Adult Hematology Department, Saint-Louis University Hospital, AP-HP, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Lengliné
authors.affiliation: Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Roussel
authors.affiliation: Department of Gastroenterology, Saint-Louis University Hospital, AP-HP, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Gornet
authors.affiliation: Department of Digestive and Endocrine Surgery, Saint-Louis University Hospital, AP-HP, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Munoz-Bongrand
authors.affiliation: Radiation-Oncology Department, Saint-Louis University Hospital, AP-HP, Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Quéro
authors.affiliation: Biostatistics Department, Saint-Louis University Hospital, AP-HP, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Resche-Rigon
authors.affiliation: Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, Paris, France. Electronic address: emmanuel.canet@aphp.fr.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
mesh_terms: D000328:Adult; D016638:Critical Illness; D004630:Emergencies; D044504:Enterocolitis, Neutropenic / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D009369:Neoplasms; D000072878:Simplified Acute Physiology Score
keywords: Cancer; Chemotherapy; Clostridium difficile colitis; Gastrointestinal diseases; Neutropenic enterocolitis; Toxicity