Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country.

Autor: Nassar Junior AP; A.C. Camargo Cancer Center, São Paulo, Brazil., Trevisani MDS; A.C. Camargo Cancer Center, São Paulo, Brazil., Bettim BB; A.C. Camargo Cancer Center, São Paulo, Brazil., Zampieri FG; ID'Or, Research and Education Institute, São Paulo, Brazil.; Research Institute, HCor-Hospital do Coração, São Paulo, Brazil.; Center for Epidemiological and Clinical Research, University of Odense, Odense, Denmark., Carvalho JA Jr; Hospital São Luiz-Rede D'Or, São Paulo, Brazil., Silva A Jr; Hospital Alemão Oswaldo Cruz, São Paulo, Brazil., de Freitas FGR; Hospital Sepaco, São Paulo, Brazil., Pinto JEDSS; Hospital Norte D'Or, Rio de Janeiro, Brazil., Romano E; HCor-Hospital do Coração, São Paulo, Brazil., Ramos SR; Hospital São Luiz-Unidade Assunção, São Bernardo do Campo, Brazil., Faria GBA; Hospital Oeste D'Or, Rio de Janeiro, Brazil., Silva UVAE; Fundação Pio XII-Hospital de Câncer de Barretos, Barretos, Brazil., Santos RC; Hospital Estadual Adão Pereira Nunes, Duque de Caxias, Brazil., Tommasi EO; Hospital Israelita Albert Sabin, Rio de Janeiro, Brazil., de Moraes APP; Hospital de Câncer do Maranhão Tarquínio Lopes Filho, São Luís, Brazil., Cruz BAD; Instituto Nacional de Câncer-HC II, Rio de Janeiro, Brazil., Bozza FA; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.; Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil., Caruso P; A.C. Camargo Cancer Center, São Paulo, Brazil.; Discipline of Pulmonology, Heart Institute, University of São Paulo, São Paulo, Brazil., Salluh JIF; D'Or Institute for Research and Education, Rio de Janeiro, Brazil., Soares M; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Aug 21; Vol. 15 (8), pp. e0238124. Date of Electronic Publication: 2020 Aug 21 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0238124
Abstrakt: 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.
Competing Interests: Dr. Soares and Dr. Salluh are founders and equity shareholders of Epimed Solutions®, which commercializes the Epimed Monitor System®, a cloud-based software for ICU management and benchmarking. The other authors declare that they have no conflict of interest. Dr. Zampieri has received grant for an investigator-initiated clinical trial from Bactiguard®, Sweden, which is unrelated to the aspects of this work. These do not alter our adherence to Plos One policies on sharing data and materials.
Databáze: MEDLINE
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