Outcomes of patients

Published Date: 09th August 2016

Publication Authors: Tridente A

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Introduction

Palliative oncology patients are admitted to critical care not uncommonly, outcomes are variable and often difficult to predict. We sought to observe Intensive care unit (ICU) and hospital outcomes of palliative oncology patients, in relation to demographic, disease and organ failure criteria.

Methods

Retrospective review of the electronic database and notes of patients admitted to ICU between January 2012 and October 2014 was undertaken. Patients without a formal palliative diagnosis or with a diagnosis of haematological malignancy, were excluded. Demographics, functional status, current cancer treatment, interventions received, and palliative care team involvement were amongst parameters collected. SAPS II, APACHE II scores and ICU outcome were recorded. STATA 14.1 was used for Logistic regression analyses.

Results

31 patients were identified, median (IQR) age was 68 (62-76) years, 14 (45.2 %) were male, median (IQR) SAPS II score was 56 (53-71). Of 28 patients, where information was available, 18 (64.3 %) had metastatic disease; 16 (61.5 %) were undergoing palliative chemotherapy and/or radiotherapy, 5 (19.2 %) palliative surgical intervention. Median (IQR) LOS was 3.25 (1.3-5.1) days and 6 (19.4 %) patients had died at CC discharge. Hospital mortality was 29.6 %. Median survival was 7 days in hospital patients and 143 days in patients discharged home. At logistic regression analysis, adjusted for age and gender, the only factor associated with mortality at ICU discharge was SAPS II score (OR 0.9, 95%CI 0.8-1, p = 0.046), while length of stay (LOS), type of palliative treatment received prior to ICU admission, metastatic spread, neutropenia, smoking and diabetic status and highest recorded lactate in the 24 hours prior to ICU admission seemed to not be associated with ICU outcome. The lack of statistical significance for these correlations may be related to the small sample size.

Conclusions

A high SAPS II score may confer accurate prognostic information in the context of critically unwell palliative cancer patients. Overall ICU mortality was lower than those documented by previous works (47-70 %), [1][2][3] this may be related to strict triage by both the ICU and oncology teams. Median survival of palliative oncology patients admitted to critical care remains poor.

Marshall, R; Gilpin, T; Tridente, A; Raithatha, A. (2016). Outcomes of patients admitted to a large UK critical care department with palliative oncological diagnoses​ . Critical Care. 20 (Suppl 2), 160

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