Early intervention on the outcomes in critically ill cancer patients admitted to intensive care units

摘要

Purpose: To determine whether earlier intervention was associated with decreased mortality in critically ill cancer patients admitted to an intensive care unit (ICU). Methods: A retrospective observational study was performed of 199 critically ill cancer patients admitted to the ICU from the general ward between January 2010 and December 2010. A logistic regression model was used to adjust for potential confounding factors in the association between time to intervention and inhospital mortality. Results: In-hospital mortality was 52 %, with a median Simplified Acute Physiology Score 3 (SAPS 3) of 80 [interquartile range (IQR) 67-93], and a median Sequential Organ Failure Assessment (SOFA) score of 8 (IQR 5-11). Median time from physiological derangement to intervention (time to intervention) prior to ICU admission was 1.5 (IQR 0.6-4.3) h. Median time to intervention was significantly shorter in survivors than in non-survivors (0.9 vs. 3.0 h; p0.001). Additionally, the mortality rates increased significantly with increasing quartiles of time to intervention (p0.001, test for trend). Other factors associated with in-hospital mortality were severity of illness, performance status, hematologic malignancy, stem-cell transplantation, presence of three or more abnormal physiological variables, time from derangement to ICU admission, presence of infection, need for mechanical ventilation and vasopressor, and low PaO 2/FiO 2 ratio. Even after adjusting for potential confounding factors, time to intervention was still significantly associated with hospital mortality (adjusted odds ratio 1.445, 95 % confidence interval 1.217-1.717). Conclusions: Early intervention before ICU admission was independently associated with decreased inhospital mortality in critically ill cancer patients admitted to the ICU.