Short‐ and long‐term outcomes of neutropenic cancer patients in intensive care according to requirement for invasive ventilation
| Autor: | Mandy Way, Michael C. Reade, Jayesh Dhanani, David Mackintosh |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Critical Care medicine.medical_treatment Population 030204 cardiovascular system & hematology Neutropenia law.invention 03 medical and health sciences 0302 clinical medicine law Neoplasms Intensive care Internal Medicine medicine Humans Hospital Mortality 030212 general & internal medicine education Retrospective Studies Mechanical ventilation education.field_of_study Noninvasive Ventilation business.industry Retrospective cohort study medicine.disease Intensive care unit Intensive Care Units Emergency medicine business Febrile neutropenia Cohort study |
| Zdroj: | Internal Medicine Journal. 50:603-611 |
| ISSN: | 1445-5994 1444-0903 |
| DOI: | 10.1111/imj.14721 |
| Popis: | Neutropenic fever is a frequently encountered complication when caring for cancer patients and can lead to intensive care admission, with high mortality rates in those patients who require invasive mechanical ventilation (IMV). Although hospital survival in this population has improved, long-term outcomes of critically ill neutropenic cancer patients have not been well defined.To evaluate short- and long-term outcomes of neutropenic cancer patients admitted to intensive care, according to requirement for invasive ventilation. Additionally, we aimed to determine predictors of poor clinical outcomes in this group.A retrospective cohort study of neutropenic cancer patients admitted to our intensive care unit (ICU) from 2008 to 2016.We included 192 cancer patients of whom 100 (52.1%) required IMV. Overall ICU mortality was 29.7% and 12-month post-ICU mortality was 61.5%. Patients requiring IMV had significantly higher short- and long-term mortality (P 0.001). Multivariate analysis determined three variables to be predictors of mortality at ICU discharge in the whole cohort: IMV (OR 13.52), renal replacement therapy (RRT, OR 2.37) and higher APACHE II scores (OR 1.1 for each unit increase). These variables were identical in the subgroup requiring invasive ventilation, with RRT (OR 2.76) and APACHE II scores (OR 1.1 for each unit increase) predicting short-term mortality.Neutropenic cancer patients admitted to ICU have lower short-term mortality than previously reported in cohort studies, however their mortality rises significantly following discharge from ICU. Those patients who require IMV are at significantly increased risk of both short- and long-term mortality. |
| Databáze: | OpenAIRE |
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