The decision to start chemotherapy in critically-ill cancer patients is extremely complex since their outcome or prognostic factors are not well-defined. This present study evaluated the outcomes and prognostic factors in critically ill patients with malignancies who received chemotherapy in the intensive care unit(ICU).
A retrospective analysis was performed in 64 cancer patients who received chemotherapy while undergoing intensive care from Oct, 2002 to Dec, 2008.
Majority of patients had hematologic malignancies (51 patients, 80%). The reason for ICU admission was septic shock in 19 (30%), respiratory failure 16 (25%), and renal failure 14 (22%). Median SOFA and SAPSII scores at the time of chemotherapy were 10 (6–14) and 54 (41–68), respectively. Twenty-three (36%) patients were undergoing treatment for concomitant infections at the time of chemotherapy. Thirty-eight (59%) patients received mechanical ventilation and 20 (31%) patients underwent renal replacement therapy at the time of chemotherapy. ICU mortality was 39% (25 of 64 patients) and causes of deaths were septic shock in 13(52%), hepatic failure 4(16%), and bleeding 2(8%). ICU mortality after chemotherapy was significantly increased by the need for mechanical ventilation (OR 9.6, 95% CI 1.6–58.8, p = 0.014) and SOFA score of 10 or more (OR16.0, 95% CI 1.5–169.3, p = 0.021) at the time of chemotherapy.
Chemotherapy in the ICU for critically ill patients with malignancies could be considered even when infection or organ failure was present. However, severity of organ failure including respiratory failure needed mechanical ventilation was associated with an increased mortality after chemotherapy during ICU stay.
cancer, chemotherapy, Intensive care unit.
Jae-Uk Song, No Financial Disclosure Information; No Product/Research Disclosure Information