Prognostic factors, long-term survival, and outcome of cancer patients receiving chemotherapy in the intensive care unit
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Prognostic factors, long-term survival, and outcome of cancer patients receiving chemotherapy in the intensive care unit. / Wohlfarth, Philipp; Staudinger, Thomas; Sperr, Wolfgang R; Bojic, Andja; Robak, Oliver; Hermann, Alexander; Laczika, Klaus; Carlström, Alexander; Riss, Katharina; Rabitsch, Werner; Bojic, Marija; Knoebl, Paul; Locker, Gottfried J; Obiditsch, Maria; Fuhrmann, Valentin; Schellongowski, Peter; Arbeitsgruppe für hämato-onkologische Intensivmedizin der Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin (ÖGIAIN).
In: ANN HEMATOL, Vol. 93, No. 10, 01.10.2014, p. 1629-36.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Prognostic factors, long-term survival, and outcome of cancer patients receiving chemotherapy in the intensive care unit
AU - Wohlfarth, Philipp
AU - Staudinger, Thomas
AU - Sperr, Wolfgang R
AU - Bojic, Andja
AU - Robak, Oliver
AU - Hermann, Alexander
AU - Laczika, Klaus
AU - Carlström, Alexander
AU - Riss, Katharina
AU - Rabitsch, Werner
AU - Bojic, Marija
AU - Knoebl, Paul
AU - Locker, Gottfried J
AU - Obiditsch, Maria
AU - Fuhrmann, Valentin
AU - Schellongowski, Peter
AU - Arbeitsgruppe für hämato-onkologische Intensivmedizin der Österreichischen Gesellschaft für Internistische und Allgemeine Intensivmedizin und Notfallmedizin (ÖGIAIN)
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Prognostic factors and outcomes of cancer patients with acute organ failure receiving chemotherapy (CT) in the intensive care unit (ICU) are still incompletely described. We therefore retrospectively studied all patients who received CT in any ICU of our institution between October 2006 and November 2013. Fifty-six patients with hematologic (n = 49; 87.5 %) or solid (n = 7; 12.5 %) malignancies, of which 20 (36 %) were diagnosed in the ICU, were analyzed [m/f ratio, 33:23; median age, 47 years (IQR 32 to 62); Charlson Comorbidity Index (CCI), 3 (2 to 5); Simplified Acute Physiology Score II (SAPS II), 50 (39 to 61)]. The main reasons for admission were acute respiratory failure, acute kidney failure, and septic shock. Mechanical ventilation and vasopressors were employed in 34 patients (61 %) respectively, hemofiltration in 22 (39 %), and extracorporeal life support in 7 (13 %). Twenty-seven patients (48 %) received their first CT in the ICU. Intention of therapy was cure in 46 patients (82 %). Tumor lysis syndrome (TLS) developed in 20 patients (36 %). ICU and hospital survival was 75 and 59 %. Hospital survivors were significantly younger; had lower CCI, SAPS II, and TLS risk scores; presented less often with septic shock; were less likely to develop TLS; and received vasopressors, hemofiltration, and thrombocyte transfusions in lower proportions. After discharge, 88 % continued CT and 69 % of 1-year survivors were in complete remission. Probability of 1- and 2-year survival was 41 and 38 %, respectively. Conclusively, administration of CT in selected ICU cancer patients was feasible and associated with considerable long-term survival as well as long-term disease-free survival.
AB - Prognostic factors and outcomes of cancer patients with acute organ failure receiving chemotherapy (CT) in the intensive care unit (ICU) are still incompletely described. We therefore retrospectively studied all patients who received CT in any ICU of our institution between October 2006 and November 2013. Fifty-six patients with hematologic (n = 49; 87.5 %) or solid (n = 7; 12.5 %) malignancies, of which 20 (36 %) were diagnosed in the ICU, were analyzed [m/f ratio, 33:23; median age, 47 years (IQR 32 to 62); Charlson Comorbidity Index (CCI), 3 (2 to 5); Simplified Acute Physiology Score II (SAPS II), 50 (39 to 61)]. The main reasons for admission were acute respiratory failure, acute kidney failure, and septic shock. Mechanical ventilation and vasopressors were employed in 34 patients (61 %) respectively, hemofiltration in 22 (39 %), and extracorporeal life support in 7 (13 %). Twenty-seven patients (48 %) received their first CT in the ICU. Intention of therapy was cure in 46 patients (82 %). Tumor lysis syndrome (TLS) developed in 20 patients (36 %). ICU and hospital survival was 75 and 59 %. Hospital survivors were significantly younger; had lower CCI, SAPS II, and TLS risk scores; presented less often with septic shock; were less likely to develop TLS; and received vasopressors, hemofiltration, and thrombocyte transfusions in lower proportions. After discharge, 88 % continued CT and 69 % of 1-year survivors were in complete remission. Probability of 1- and 2-year survival was 41 and 38 %, respectively. Conclusively, administration of CT in selected ICU cancer patients was feasible and associated with considerable long-term survival as well as long-term disease-free survival.
KW - Acute Kidney Injury
KW - Adult
KW - Aged
KW - Antineoplastic Combined Chemotherapy Protocols
KW - Austria
KW - Blood Component Transfusion
KW - Chemotherapy-Induced Febrile Neutropenia
KW - Disease-Free Survival
KW - Disseminated Intravascular Coagulation
KW - Extracorporeal Membrane Oxygenation
KW - Female
KW - Granulocyte Colony-Stimulating Factor
KW - Hematologic Neoplasms
KW - Hemofiltration
KW - Hospital Mortality
KW - Hospitals, University
KW - Humans
KW - Intensive Care
KW - Intensive Care Units
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Neoplasms
KW - Prognosis
KW - Remission Induction
KW - Respiration, Artificial
KW - Respiratory Insufficiency
KW - Retrospective Studies
KW - Severity of Illness Index
KW - Shock, Septic
KW - Tumor Lysis Syndrome
KW - Vasoconstrictor Agents
U2 - 10.1007/s00277-014-2141-x
DO - 10.1007/s00277-014-2141-x
M3 - SCORING: Journal article
C2 - 24997682
VL - 93
SP - 1629
EP - 1636
JO - ANN HEMATOL
JF - ANN HEMATOL
SN - 0939-5555
IS - 10
ER -
