Assi Hazem I, Halim Nour Abdul, Alameh Ibrahim, Khoury Jessica, Nahra Vicky, Sukhon Fares, Charafeddine Maya, El Nakib Clara, Moukalled Nour, Bou Zerdan Maroun, Bou Khalil Pierre
Department of Internal Medicine, Division of Hematology and Oncology, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, Division of Pulmonary and Critical Care, American University of Beirut Medical Center, Beirut, Lebanon.
Crit Care Res Pract. 2021 Sep 1;2021:4792309. doi: 10.1155/2021/4792309. eCollection 2021.
Decisions regarding whether advanced cancer patients should be admitted to the ICU are based on a complex suite of considerations, including short- and long-term prognosis, quality of life, and therapeutic options to treat cancer. We aimed to describe demographic, clinical, and survival data and to identify factors associated with mortality in critically ill advanced cancer patients with nonelective admissions to general ICUs.
Critically ill adult (≥18 years old) cancer patients nonelectively admitted to the intensive care units at the American University of Beirut Medical Center between August 1 2015 and March 1 2019 were included. Demographic, clinical, and laboratory data were prospectively collected from the first day of ICU admission up to 30 days after discharge. This study was strictly observational, and clinical decisions were left to the discretion of the ICU team and attending physician.
272 patients were enrolled in the study between August 1 2015 and March 1 2019, with an ICU mortality rate of 43.4%, with the number rising to 59% within 30 days of ICU discharge. The mean length of stay in our ICU was 14 days (IQR: 1-120) with a median overall survival of 22 days since the date of ICU admission. The major reasons for unplanned ICU admission were sepsis/septic shock (54%) and respiratory failure (33.1%). Cox regression analysis revealed 7 major predictors of poor prognosis. Direct admission from the ED was associated with a higher risk of mortality (48.9%) than being transferred from the floor (32.6%) (=0.014).
Our study has shown that being directly admitted to the ICU from the ED rather than being transferred from regular wards, developing AKI, sepsis, MOF, and ARDS, or having an uncontrolled malignancy are all predictive factors for short-term mortality in critically ill cancer patients nonelectively admitted to the ICU. Vasopressor use and mechanical ventilation were also predictors of mortality.
关于晚期癌症患者是否应入住重症监护病房（ICU）的决策基于一系列复杂的考量因素，包括短期和长期预后、生活质量以及治疗癌症的选择。我们旨在描述人口统计学、临床和生存数据，并确定非选择性入住综合ICU的重症晚期癌症患者的死亡相关因素。
纳入2015年8月1日至2019年3月1日期间在美国贝鲁特美国大学医学中心非选择性入住重症监护病房的成年（≥18岁）重症癌症患者。从ICU入院第一天直至出院后30天前瞻性收集人口统计学、临床和实验室数据。本研究严格为观察性研究，临床决策由ICU团队和主治医生自行决定。
2015年8月1日至2019年3月1日期间，272例患者纳入本研究，ICU死亡率为43.4%，在ICU出院后30天内这一数字升至59%。我们ICU的平均住院时间为14天（四分位间距：1 - 120），自ICU入院之日起总体中位生存期为22天。非计划入住ICU的主要原因是脓毒症/脓毒性休克（54%）和呼吸衰竭（33.1%）。Cox回归分析揭示了7个预后不良的主要预测因素。与从病房转入相比，直接从急诊科入院的死亡风险更高（48.9%比32.6%）（P = 0.014）。
我们的研究表明，对于非选择性入住ICU的重症癌症患者，直接从急诊科而非从普通病房转入ICU、发生急性肾损伤、脓毒症、多器官功能衰竭和急性呼吸窘迫综合征，或患有无法控制的恶性肿瘤，均为短期死亡的预测因素。使用血管活性药物和机械通气也是死亡的预测因素。
