학술논문
Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country.
Document Type
Article
Author
Nassar Junior, Antonio Paulo; Trevisani, Mariane da Silva; Bettim, Barbara Beltrame; Zampieri, Fernando Godinho; Carvalho, José Albani; Silva, Amilton; de Freitas, Flávio Geraldo Rezende; Pinto, Jorge Eduardo da Silva Soares; Romano, Edson; Ramos, Silvia Regina; Faria, Guilherme Brenande Alves; Silva, Ulysses V. Andrade e; Santos, Robson Correa; Tommasi, Edmundo de Oliveira; de Moraes, Ana Paula Pierre; Cruz, Bruno Azevedo da; Bozza, Fernando Augusto; Caruso, Pedro; Salluh, Jorge Ibrahin Figueira; Soares, Marcio
Source
Subject
*INTENSIVE care units
*OLDER patients
*CANCER patients
*MIDDLE-income countries
*HOSPITAL mortality
*CURRICULUM
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Language
ISSN
1932-6203
Abstract
Background: Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs). Methods: This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality. Results: Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01–3.00), hematological cancer (OR = 2.32; CI 95%, 1.75–3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33–1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88–5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25–1.89) and renal replacement (OR = 1.81; CI 95%, 1.29–2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52–0.96). Conclusions: Hospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality. [ABSTRACT FROM AUTHOR]