Long-Term Outcome of Critically Ill Advanced Cancer Patients Managed in an Intermediate Care Unit
-
Fernández Ros, Nerea
- Alegre, Félix
- Rodríguez Rodriguez, Javier 2
-
Landecho, Manuel F.
- Sunsundegui, Patricia
- Gúrpide, Alfonso
-
Lecumberri, Ramón
- Sanz, Eva
- García, Nicolás
- Quiroga, Jorge
-
Lucena, Juan Felipe
-
1
Universidad de Navarra
info
-
2
Clínica Universitaria de Navarra
info
-
3
Instituto de Investigación Sanitaria de Navarra
info
Instituto de Investigación Sanitaria de Navarra
Pamplona, España
-
4
Universidad Europea de Madrid
info
-
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
ISSN: 2077-0383
Año de publicación: 2022
Volumen: 11
Número: 12
Páginas: 3472
Tipo: Artículo
Otras publicaciones en: Journal of Clinical Medicine
Objetivos de desarrollo sostenible
Resumen
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.
Información de financiación
This research received no external fundingReferencias bibliográficas
- 10.1002/cncr.32802
- 10.1186/cc7713
- 10.1097/CCM.0b013e3181c0349e
- 10.1097/00003246-200005000-00011
- 10.1097/00003246-198610000-00007
- 10.1097/00003246-199310000-00025
- 10.1016/j.rmed.2004.11.014
- 10.1002/jhm.1905
- 10.1159/000516329
- 10.1097/00003246-199803000-00039
- 10.1007/s00134-005-2762-6
- 10.1007/s00134-005-2763-5
- 10.1371/journal.pone.0077229
- 10.1007/s00134-006-0374-4
- 10.1007/s00134-010-1807-7
- 10.1371/journal.pone.0131329
- 10.1001/jama.1993.03510240069035
- 10.1007/s001340051350
- 10.1007/s00134-009-1625-y
- 10.1378/chest.09-2863
- 10.1097/01.CCM.0000157752.26180.F1
- 10.1634/theoncologist.2018-0328
- 10.1097/CCM.0000000000001648
- 10.1371/journal.pone.0211240
- 10.1097/CCM.0000000000002589
- 10.1186/s13613-018-0426-2
- 10.1097/CCM.0000000000001568
- 10.1097/00003246-199911000-00005
- 10.1002/hon.2595
- 10.1371/journal.pone.0183073
- 10.1164/rccm.201406-1117PP