• Fernando G Zampieri, Thiago G Romano, Salluh Jorge I F JIF Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil., Leandro U Taniguchi, Pedro V Mendes, Antonio P Nassar, Roberto Costa, William N Viana, Marcelo O Maia, Mariza F A Lima, Sylas B Cappi, Alexandre G R Carvalho, Fernando V C De Marco, Marcelo S Santino, Eric Perecmanis, Fabio G Miranda, Grazielle V Ramos, Aline R Silva, Paulo M Hoff, Fernando A Bozza, and Marcio Soares.
• Department of Critical Care, D'Or Institute for Research and Education, 30. Botafogo, Rio de Janeiro, Brazil.
• Intensive Care Med. 2021 Feb 1; 47 (2): 170-179.

PurposeTo describe trends in outcomes of cancer patients with unplanned admissions to intensive-care units (ICU) according to cancer type, organ support use, and performance status (PS) over an 8-year period.MethodsWe retrospectively analyzed prospectively collected data from all cancer patients admitted to 92 medical-surgical ICUs from July/2011 to June/2019. We assessed trends in mortality through a Bayesian hierarchical model adjusted for relevant clinical confounders and whether there was a reduction in ICU length-of-stay (LOS) over time using a competing risk model.Results32,096 patients (8.7% of all ICU admissions; solid tumors, 90%; hematological malignancies, 10%) were studied. Bed/days use by cancer patients increased up to more than 30% during the period. Overall adjusted mortality decreased by 9.2% [95% credible interval (CI), 13.1-5.6%]. The largest reductions in mortality occurred in patients without need for organ support (9.6%) and in those with need for mechanical ventilation (MV) only (11%). Smallest reductions occurred in patients requiring MV, vasopressors, and dialysis (3.9%) simultaneously. Survival gains over time decreased as PS worsened. Lung cancer patients had the lowest decrease in mortality. Each year was associated with a lower sub-hazard for ICU death [SHR 0.93 (0.91-0.94)] and a higher chance of being discharged alive from the ICU earlier [SHR 1.01 (1-1.01)].ConclusionOutcomes in critically ill cancer patients improved in the past 8 years, with reductions in both mortality and ICU LOS, suggesting improvements in overall care. However, outcomes remained poor in patients with lung cancer, requiring multiple organ support and compromised PS.

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