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Critical Care |

Application of the Mexican Sequential Organ Failure Assessment Score to Critically Ill Cancer Patients

Silvio Ñamendys-Silva, MS; Yves Jarquín-Badiola, MD; Francisco Garcia-Guillen, MD; Mireya Barragan-Dessavre, MD; Andoreni Bautista-Ocampo, MD; Juan Arredondo-Armenta, MD; Humberto García-Guevara, MD; Gonzalo Montalvo-Esquivel, MD; Julia Texcocano- Becerra, RN; Angel Herrera-Gómez, MD; Abelardo Meneses-García, MD; Paulina Correa-García, MD
Author and Funding Information

Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico; Division of Education and Research, Women's Hospital, Mexico City, Mexico


Chest. 2015;148(4_MeetingAbstracts):346A. doi:10.1378/chest.2270123
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Abstract

SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To explore the usefulness of the Mexican Sequential Organ Failure Assessment (MEXSOFA) score for assessing the risk of mortality for critically ill cancer patients in the hospital.

METHODS: The present study was an observational and descriptive study that included 426 critically ill cancer patients admitted to the ICU of the Instituto Nacional de Cancerología, Mexico, between January 2013, and December 2014. The MEXSOFA score was calculated during the first 24 hours after admission to the ICU. The MEXSOFA was calculated using the original SOFA scoring system with two modifications: the PaO2/FiO2 ratio was replaced with the SpO2/FiO2 ratio, and the evaluation of neurologic dysfunction was excluded. Discrimination of the MEXSOFA scores was quantified by the area under the receiver operating characteristic (AUROC) curve. Hospital mortality was the end point. A two-sided P value <0.05 was used to determine statistical significance.

RESULTS: The ICU and hospital mortality rates were 23.9% and 34.5 %, respectively. Of the 426 patients included in this study, 314 (73.7%) had solid tumors, and 112 (26.3%) had hematological malignancies. The median MEXSOFA score of patients having survived the hospital stay was 5 (range 3-8), and of the patients not surviving the hospital stay was 10 (range 7-12). Patients with an MEXSOFA score of 6 points or less calculated during the first 24 h after admission to the ICU had a hospital mortality rate of 12.5% (23/183), while those with an MEXSOFA score of 7 points or more had a mortality rate of 51.0%(124/243) (p<0.0001). The AUROC curve of the MEXSOFA score for predicting hospital mortality were 0.77 [95% confidence interval (CI): 0.73-0.81, p<0.0001]. A MEXSOFA score greater than 6 points had a sensitivity of 84.3% (95% CI: 82.1-93.1), specificity of 57.3% (95% CI: 51.3-63.2), positive predictive value of 51.0 (95% CI: 44.6-57.5), and negative predictive value of 87.4 (95% CI: 81.7-91.9) to predict death in the hospital.

CONCLUSIONS: The ICU mortality for critically ill cancer patients in this study was 23.9 % and the hospital mortality was 34.5 %.The MEXSOFA score demonstrated a good level of discrimination for hospital mortality prediction.

CLINICAL IMPLICATIONS: The results of this study suggest that hospital mortality in critically ill cancer patients depends primarily on the number of organ dysfunctions. The MEXSOFA score may provide an alternate method for assessing hospital mortality in critically ill cancer patients.

DISCLOSURE: The following authors have nothing to disclose: Silvio Ñamendys-Silva, Yves Jarquín-Badiola, Paulina Correa-García, Francisco Garcia-Guillen, Mireya Barragan-Dessavre, Andoreni Bautista-Ocampo, Juan Arredondo-Armenta, Humberto García-Guevara, Gonzalo Montalvo-Esquivel, Julia Texcocano- Becerra, Angel Herrera-Gómez, Abelardo Meneses-García

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