Critical Care |

Continuous Renal Replacement Therapy (CRRT) in Patients With Active Cancer? Yes or No FREE TO VIEW

Djuro Karanovic, MD; Christopher Thomas, BS; Charles Read, MD
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Medstar Georgetown University Hospital, Washington, DC

Chest. 2015;148(4_MeetingAbstracts):236A. doi:10.1378/chest.2281074
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SESSION TITLE: Critical Care Posters II

SESSION TYPE: Original Investigation Poster

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

PURPOSE: To determine mortality rates of cancer patients with comorbidities undergoing CRRT in the ICU.

METHODS: We identified 563 consecutive patients who underwent CRRT in the medical, neurological and surgical ICUs at Medstar Georgetown University Hospital between Jan 2012 and Jan 2015. Sixty-two of these patients had active cancer and sixty-nine with prior history of cancer now in remission. We evaluated mortality rates, comorbidities, total length of stay, total CRRT days and code status changes.

RESULTS: Patients with active cancer had an average age of 60 years and 48% were female. The mean hospital stay was 26.7 days. The in-hospital mortality rate was 77% (48 of 62) for patients with active cancer undergoing CRRT. The mean duration of CRRT was 9.7 days, both for patients who died and for patients survivors. When compared to cancer in remission, active malignancy increased risk of death (RR 1.27 CI 1.01 to 1.60, p=0.04). In patients with active cancer and respiratory failure requiring intubation, the mortality rate increased to 86%. All twelve patients with comorbid cirrhosis died. Palliative care was consulted for only 30% of patients with active cancer. In total, 12 out of the 48 patients or 25% with active cancer received some form of resuscitation at the time of death.

CONCLUSIONS: Active cancer appears to increase mortality among patients receiving CRRT in the ICU when compared to patients with cancer in remission. Additionally, comorbidities such as respiratory failure and cirrhosis were associated with higher mortality.

CLINICAL IMPLICATIONS: Clinicians should consider initiating a goals-of-care discussion prior to starting CRRT in patients with active cancer.

DISCLOSURE: The following authors have nothing to disclose: Djuro Karanovic, Christopher Thomas, Charles Read

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