AlSaied Ghiath, Lababidi Hani, AlHawdar Taher, AlZahrani Saud, AlMotairi Abdullah, AlMaani Mohamad
Department of Adult Critical Care, King Fahad Medical City, Boston, MA, USA.
Department of Health Professions Education, MGH-Institute of Health Professions, Boston, MA, USA.
Saudi J Med Med Sci. 2024 Apr-Jun;12(2):153-161. doi: 10.4103/sjmms.sjmms_145_23. Epub 2024 Apr 5.
Understanding the characteristics and outcomes of cancer patients with unplanned ICU admission is imperative for therapeutic decisions and prognostication purposes.
To describe the clinical characteristics of patients with hematological and non-hematological malignancies (NHM) who require unplanned ICU admission and to determine the predictors of mortality and long-term survival.
This retrospective study included all patients with cancer who had an unplanned ICU admission between 2011 and 2016 at a tertiary hospital in Saudi Arabia. The following variables were collected: age, gender, ICU length of stay (LOS), APACHE II score, type of malignancy, febrile neutropenia, source and time of admission, and need for mechanical ventilation (MV), renal replacement therapy (RRT), and treatment with vasopressors (VP). Predictors of mortality and survival rates at 28 days and 3, 6, and 12 months were calculated.
The study included 410 cancer patients with 466 unplanned ICU admissions. Of these, 52% had NHM. The average LOS in the ICU was 9.6 days and the mean APACHE score was 21.9. MV was needed in 73% of the patients, RRT in 15%, and VP in 24%, while febrile neutropenia was present in 24%. There were statistically significant differences between survivors and non-survivors in the APACHE II score (17.7 ± 8.0 vs. 25.6 ± 9.2), MV use (52% vs. 92%), need for RRT (6% vs. 23%), VP use (42% vs. 85%), and presence of febrile neutropenia (18% vs. 30%). The predictors of mortality were need for MV (OR = 4.97), VP (OR = 3.43), RRT (OR = 3.31), and APACHE II score (OR = 1.10). Survival rates at 28 days, 3, 6, and 12 months were 52%, 28%, 22%, and 15%, respectively.
The survival rate of cancer patients with an unplanned admission to the ICU remains low. Predictors of mortality include need for MV, RRT, and VP and presence of febrile neutropenia. About 85% of cancer patients died within 1 year after ICU admission.
了解癌症患者非计划入住重症监护病房（ICU）的特征和结局对于治疗决策和预后评估至关重要。
描述血液系统恶性肿瘤和非血液系统恶性肿瘤（NHM）患者非计划入住ICU的临床特征，并确定死亡率和长期生存的预测因素。
这项回顾性研究纳入了2011年至2016年期间在沙特阿拉伯一家三级医院非计划入住ICU的所有癌症患者。收集了以下变量：年龄、性别、ICU住院时间（LOS）、急性生理与慢性健康状况评分系统II（APACHE II）评分、恶性肿瘤类型、发热性中性粒细胞减少症、入院来源和时间，以及机械通气（MV）、肾脏替代治疗（RRT）和血管活性药物（VP）治疗的需求。计算了28天以及3、6和12个月时死亡率和生存率的预测因素。
该研究纳入了410例癌症患者的466次非计划ICU入住。其中，52%患有NHM。ICU的平均住院时间为9.6天，APACHE平均评分为21.9。73%的患者需要MV，15%需要RRT，24%需要VP，24%存在发热性中性粒细胞减少症。幸存者和非幸存者在APACHE II评分（17.7±8.0对25.6±9.2）、MV使用（52%对92%）、RRT需求（6%对23%）、VP使用（42%对85%）以及发热性中性粒细胞减少症的存在（18%对30%）方面存在统计学显著差异。死亡率的预测因素为MV需求（比值比[OR]=4.97）、VP（OR=3.43）、RRT（OR=3.31）和APACHE II评分（OR=1.10）。28天、3、6和12个月时的生存率分别为52%、28%、22%和15%。
癌症患者非计划入住ICU的生存率仍然很低。死亡率的预测因素包括MV、RRT和VP的需求以及发热性中性粒细胞减少症的存在。约85%的癌症患者在入住ICU后1年内死亡。
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