Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.

<h4>Introduction</h4>Given clinicians' frequent concerns about unfavourable outcomes, Intensive Care Unit (ICU) triage decisions in acutely ill cancer patients can be difficult, as clinicians may have doubts about the appropriateness of an ICU admission. To aid to this decision maki...

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Autores principales:	Esther N van der Zee, Lianne M Noordhuis, Jelle L Epker, Nikki van Leeuwen, Bas P L Wijnhoven, Dominique D Benoit, Jan Bakker, Erwin J O Kompanje
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/43f59fd92f354f328529d856331a7c99
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spelling	oai:doaj.org-article:43f59fd92f354f328529d856331a7c992021-12-02T20:07:09ZAssessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.1932-620310.1371/journal.pone.0252771https://doaj.org/article/43f59fd92f354f328529d856331a7c992021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252771https://doaj.org/toc/1932-6203<h4>Introduction</h4>Given clinicians' frequent concerns about unfavourable outcomes, Intensive Care Unit (ICU) triage decisions in acutely ill cancer patients can be difficult, as clinicians may have doubts about the appropriateness of an ICU admission. To aid to this decision making, we studied the survival and performance status of cancer patients 2 years following an unplanned ICU admission.<h4>Materials and methods</h4>This was a retrospective cohort study in a large tertiary referral university hospital in the Netherlands. We categorized all adult patients with an unplanned ICU admission in 2017 into two groups: patients with or without an active malignancy. Descriptive statistics, Pearson's Chi-square tests and the Mann-Whitney U tests were used to evaluate the primary objective 2-year mortality and performance status. A good performance status was defined as ECOG performance status 0 (fully active) or 1 (restricted in physically strenuous activity but ambulatory and able to carry out light work). A multivariable binary logistic regression analysis was used to identify factors associated with 2-year mortality within cancer patients.<h4>Results</h4>Of the 1046 unplanned ICU admissions, 125 (12%) patients had cancer. The 2-year mortality in patients with cancer was significantly higher than in patients without cancer (72% and 42.5%, P <0.001). The median performance status at 2 years in cancer patients was 1 (IQR 0-2). Only an ECOG performance status of 2 (OR 8.94; 95% CI 1.21-65.89) was independently associated with 2-year mortality.<h4>Conclusions</h4>In our study, the majority of the survivors have a good performance status 2 years after ICU admission. However, at that point, three-quarter of these cancer patients had died, and mortality in cancer patients was significantly higher than in patients without cancer. ICU admission decisions in acutely ill cancer patients should be based on performance status, severity of illness and long-term prognosis, and this should be communicated in the shared decision making. An ICU admission decision should not solely be based on the presence of a malignancy.Esther N van der ZeeLianne M NoordhuisJelle L EpkerNikki van LeeuwenBas P L WijnhovenDominique D BenoitJan BakkerErwin J O KompanjePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252771 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Esther N van der Zee Lianne M Noordhuis Jelle L Epker Nikki van Leeuwen Bas P L Wijnhoven Dominique D Benoit Jan Bakker Erwin J O Kompanje Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.
description	<h4>Introduction</h4>Given clinicians' frequent concerns about unfavourable outcomes, Intensive Care Unit (ICU) triage decisions in acutely ill cancer patients can be difficult, as clinicians may have doubts about the appropriateness of an ICU admission. To aid to this decision making, we studied the survival and performance status of cancer patients 2 years following an unplanned ICU admission.<h4>Materials and methods</h4>This was a retrospective cohort study in a large tertiary referral university hospital in the Netherlands. We categorized all adult patients with an unplanned ICU admission in 2017 into two groups: patients with or without an active malignancy. Descriptive statistics, Pearson's Chi-square tests and the Mann-Whitney U tests were used to evaluate the primary objective 2-year mortality and performance status. A good performance status was defined as ECOG performance status 0 (fully active) or 1 (restricted in physically strenuous activity but ambulatory and able to carry out light work). A multivariable binary logistic regression analysis was used to identify factors associated with 2-year mortality within cancer patients.<h4>Results</h4>Of the 1046 unplanned ICU admissions, 125 (12%) patients had cancer. The 2-year mortality in patients with cancer was significantly higher than in patients without cancer (72% and 42.5%, P <0.001). The median performance status at 2 years in cancer patients was 1 (IQR 0-2). Only an ECOG performance status of 2 (OR 8.94; 95% CI 1.21-65.89) was independently associated with 2-year mortality.<h4>Conclusions</h4>In our study, the majority of the survivors have a good performance status 2 years after ICU admission. However, at that point, three-quarter of these cancer patients had died, and mortality in cancer patients was significantly higher than in patients without cancer. ICU admission decisions in acutely ill cancer patients should be based on performance status, severity of illness and long-term prognosis, and this should be communicated in the shared decision making. An ICU admission decision should not solely be based on the presence of a malignancy.
format	article
author	Esther N van der Zee Lianne M Noordhuis Jelle L Epker Nikki van Leeuwen Bas P L Wijnhoven Dominique D Benoit Jan Bakker Erwin J O Kompanje
author_facet	Esther N van der Zee Lianne M Noordhuis Jelle L Epker Nikki van Leeuwen Bas P L Wijnhoven Dominique D Benoit Jan Bakker Erwin J O Kompanje
author_sort	Esther N van der Zee
title	Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.
title_short	Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.
title_full	Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.
title_fullStr	Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.
title_full_unstemmed	Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.
title_sort	assessment of mortality and performance status in critically ill cancer patients: a retrospective cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/43f59fd92f354f328529d856331a7c99
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Assessment of mortality and performance status in critically ill cancer patients: A retrospective cohort study.

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