Key result
Critically ill patients with an underlying malignancy had significantly lower 28-day survival compared to matched noncancer patients (82.3% vs 84.9%, p<0.001), though this disadvantage was absent in surgical ICU admissions.
Why the study?
With advances in oncology increasing ICU admissions, it is important to identify which critically ill cancer patients can benefit from ICU care similarly to noncancer patients.
Does an underlying malignancy diagnosis reduce short- and medium-term survival in critically ill adult patients admitted to the ICU?
Cohort (n=38,508)
No
Does an underlying malignancy diagnosis reduce short- and medium-term survival in critically ill adult patients admitted to the ICU?
Absolute Event Rate: 82.3% vs 84.9%
p-value: p=<0.001
While an underlying malignancy is associated with worse overall survival in the ICU, selected subgroups of cancer patients (such as those admitted electively or to surgical ICUs) have short-term survival comparable to noncancer patients.
Cancer diagnosis linked to worse ICU survival; leaves open whether to expand admission criteria without prospective confirmation.
BACKGROUND: Advances in oncology led to a substantial increase in the number of patients requiring admission to the ICU. It is significant to confirm which cancer critical patients can benefit from the ICU care like noncancer patients. METHODS: An observational retrospective cohort study using intensive care unit (ICU) admissions of Medical Information Mart for Intensive Care III from the Beth Israel Deaconess Medical Center in Boston, MA, USA between 2001 and 2012 was conducted. Propensity score matching was used to reduce the imbalance between two matched cohorts. ICU patients with cancer were compared with those without cancer in terms of patients' characteristics and survival. RESULTS: There were 38,508 adult patients admitted to ICUs during the period. The median age was 65 years (IQR, 52-77) and 8308 (21.6%) had an underlying malignancy diagnosis. The noncancer group had a significant survive advantage at the point of 28-day, 90-day, 365-day and 1095-day after ICU admission compared with cancer group (P < 0.001 for all) after PSM. Subgroup analysis showed that the diagnosis of malignancy didn't decrease 28-day and 90-day survive when patients' age ≥ 65-year, patients in surgical intensive care unit or cardiac surgery recovery unit or traumatic surgical intensive care unit, elective admissions, patients with renal replacement therapy or vasopressor support (P > 0.05 for all). CONCLUSIONS: Malignancy is a common diagnosis among ICU patients. Patients without cancer have a survive advantage compared with patients with cancer in the short- and medium-term. However, in selected groups, cancer critical patients can benefit from the ICU care service like noncancer patients in the short-term.
No takes yet. Share an insight, caveat, or question.
Yuan et al. (2021) conducted a cohort in Critical illness requiring ICU admission (n=38,508). Underlying malignancy vs. No malignancy was evaluated on 28-day survival after ICU admission (propensity score matched) (p=<0.001). Critically ill patients with an underlying malignancy had significantly lower 28-day survival compared to matched noncancer patients (82.3% vs 84.9%, p<0.001), though this disadvantage was absent in surgical ICU admissions.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: