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First published online on July 18, 2008
Chest, doi:10.1378/chest.08-0359
doi:10.1378/chest.08-0359
(Chest. 2008; 134:520-526)
© 2008 American College of Chest Physicians
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Short- and Long-term Outcomes of Critically Ill Patients With Cancer and Prolonged ICU Length of Stay

Márcio Soares, MD, PhD*; Jorge I. F. Salluh, MD, MSc; Viviane B. L. Torres, MD; Juliana V. R. Leal, MS and Nelson Spector, MD, PhD

*From the Intensive Care Unit (Drs. Soares, Salluh, and Torres, and Ms. Leal), Instituto Nacional de Câncer, and Faculdade de Medicina (Dr. Spector), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

Corrrespondence to: Márcio Soares, MD, PhD, Instituto Nacional de Câncer, Centro de Tratamento Intensivo–10° Andar, Pça. Cruz Vermelha, 23, Rio de Janeiro–RJ, Brazil; e-mail: marciosoaresms{at}yahoo.com.br

Abstract

Background:Data on patients with cancer who have a prolonged length of stay (LOS) in the ICU are scarce. The aim of the present study was to evaluate the characteristics and the outcomes of cancer patients with life-threatening complications with an ICU stay ≥ 21 days.

Methods:A cohort study performed at a 10-bed oncology medical-surgical ICU from May 2000 to December 2005. Prolonged ICU LOS was defined as an ICU stay ≥ 21 days.

Results:During the period, 1,090 patients were admitted to the ICU and 163 patients (15%) had a prolonged ICU LOS. These patients, however, accounted for 48% (5,828/12,224) of the total ICU bed-days. The hospital and 6-month mortality rates were 50% and 60%, respectively, and similar to patients with ICU LOS < 21 days (51% and 61%, respectively). ICU-acquired events and complications were common, and the most frequent were infections (90%), mechanical ventilation (99%), and need for vasopressors (88%). The number of organ failures, older age, and poor performance status were the main outcome predictors. The median long-term follow-up after hospital discharge was 537 days (range, 193 to 1,119 days), and 29 patients (18%) were alive.

Conclusions:Fifteen percent of critically ill patients with cancer had a prolonged ICU LOS. Short- and long-term survival rates were reasonable, and the prognosis was better than expected a priori. In our opinion, the length of ICU admission per se should not be used in the clinical decisions regarding the continuation of treatment in these patients.

Key Words: cancer • ICU • outcome • prolonged admission

Abbreviations: ACE-27, Adult Comorbidity Evaluation-27 • CI, confidence interval • EOL, end of life • IQR, interquartile range • LOS, length of stay • OR, odds ratio • PS, performance status • QOL, quality of life • SAPS, Simplified Acute Physiology Score • SOFA, Sequential Organ Failure Assessment






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