Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/16714
Title: Survival and functional outcomes of patients with metastatic solid organ cancer admitted to the intensive care unit of a tertiary centre
Authors: Ha, Francis J
Weickhardt, Andrew J
Parakh, Sagun
Vincent, Andrew D
Glassford, Neil J
Warrillow, Stephen
Jones, Daryl A
Date of Publication: Jun-2017
Citation: Critical Care & Resuscitation 2017; 19(2): 159-166
Abstract: OBJECTIVE: Metastatic solid organ cancer is associated with a poor prognosis, and admission of patients with these cancers to the intensive care unit remains a dilemma. We aimed to assess outcomesin a cohort of these patients who were admitted to the ICU of a general tertiary centre. DESIGN, SETTING AND PATIENTS: A retrospective observational study of patients with incurable metastatic solid organ malignancies who had unplanned admission to a tertiary hospital ICU between 1 January 2010 and 30 June 2015. MAIN OUTCOME MEASURES: Survival outcomes up to 1 year after ICU admission, and functional outcomes as measured by Eastern Cooperative Oncology Group (ECOG) grade up to 3 months after ICU discharge. We also determined rates of advance care planning documentation. RESULTS: A total of 101 patients were treated in the ICU during the study period. Hospital, 30-day and 1-year mortality rates were 35%, 41% and 77%, respectively, and the median survival was 2.3 months (95% CI, 1.1-3.9 months). On multivariable analysis, lowest albumin level (hazard ratio [HR], 1.10; 95% CI, 1.04-1.15) and highest white cell count (HR, 1.03; 95% CI, 1.00-1.07) were significant, although they were marginal predictors of poorer overall survival. Higher ECOG grade showed a trend towards significance (HR, 1.60; 95% CI, 0.94-2.73; P = 0.08). In patients alive and assessable at 1 month, 17/31 (55%) had functionally declined. At 3 months, 15/22 surviving patients (68%) had returned to their baseline, pre-ICU admission ECOG grade. Ninety per cent had no advance care directive and twothirds did not have a medical enduring power of attorney. CONCLUSIONS: Survival is poor in patients with metastatic cancer after emergent ICU admission, although functional state is often recovered by 3 months in surviving patients. Albumin level, white cell count and ECOG grade are simple prognostic markers of survival.
URI: http://ahro.austin.org.au/austinjspui/handle/1/16714
ORCID: 0000-0002-7240-4106
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/28651512
Type: Journal Article
Appears in Collections:Journal articles

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