Long-Term Outcome of Critically Ill Advanced Cancer Patients Managed in an Intermediate Care Unit

  1. Fernández Ros, Nerea
  2. Alegre, Félix
  3. Rodríguez Rodriguez, Javier 2
  4. Landecho, Manuel F.
  5. Sunsundegui, Patricia
  6. Gúrpide, Alfonso
  7. Lecumberri, Ramón
  8. Sanz, Eva
  9. García, Nicolás
  10. Quiroga, Jorge
  11. Lucena, Juan Felipe
  1. 1 Universidad de Navarra
    info

    Universidad de Navarra

    Pamplona, España

    ROR https://ror.org/02rxc7m23

  2. 2 Clínica Universitaria de Navarra
    info

    Clínica Universitaria de Navarra

    Pamplona, España

    ROR https://ror.org/03phm3r45

  3. 3 Instituto de Investigación Sanitaria de Navarra
    info

    Instituto de Investigación Sanitaria de Navarra

    Pamplona, España

  4. 4 Universidad Europea de Madrid
    info

    Universidad Europea de Madrid

    Madrid, España

    ROR https://ror.org/04dp46240

  5. 5 Centro de Investigación Biomédica en Red sobre Enfermedades Hepáticas y Digestivas
    info

    Centro de Investigación Biomédica en Red sobre Enfermedades Hepáticas y Digestivas

    Madrid, España

    ROR https://ror.org/03cn6tr16

Journal:
Journal of Clinical Medicine

ISSN: 2077-0383

Year of publication: 2022

Volume: 11

Issue: 12

Pages: 3472

Type: Article

DOI: 10.3390/JCM11123472 GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Journal of Clinical Medicine

Sustainable development goals

Abstract

Background: To analyze the long-term outcomes for advanced cancer patients admitted to an intermediate care unit (ImCU), an analysis of a do not resuscitate orders (DNR) subgroup was made. Methods: A retrospective observational study was conducted from 2006 to January 2019 in a single academic medical center of cancer patients with stage IV disease who suffered acute severe complications. The Simplified Acute Physiology Score 3 (SAPS 3) was used as a prognostic and severity score. In-hospital mortality, 30-day mortality and survival after hospital discharge were calculated. Results: Two hundred and forty patients with stage IV cancer who attended at an ImCU were included. In total, 47.5% of the cohort had DNR orders. The two most frequent reasons for admission were sepsis (32.1%) and acute respiratory failure (excluding sepsis) (38.7%). Mortality in the ImCU was 10.8%. The mean predicted in-hospital mortality according to SAPS 3 was 51.9%. The observed in-hospital mortality was 37.5% (standard mortality ratio of 0.72). Patients discharged from hospital had a median survival of 81 (30.75–391.25) days (patients with DNR orders 46 days (19.5–92.25), patients without DNR orders 162 days (39.5–632)). The observed mortality was higher in patients with DNR orders: 52.6% vs. 23.8%, p 0 < 0.001. By multivariate logistic regression, a worse ECOG performance status (3–4 vs. 0–2), a higher SAPS 3 Score and DNR orders were associated with a higher in-hospital mortality. By multivariate analysis, non-invasive mechanical ventilation, higher bilirubin levels and DNR orders were significantly associated with 30-day mortality. Conclusion: For patients with advanced cancer disease, even those with DNR orders, who suffer from acute complications or require continuous monitoring, an ImCU-centered multidisciplinary management shows encouraging results in terms of observed-to-expected mortality ratios.

Funding information

This research received no external funding

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