Background: Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). We sought to evaluate the predictors for outcome in patients with gastrointestinal (GI) cancer admitted to the ICU for nonsurgical conditions.
Patients and methods: The primary objective was to determine the predictors of hospital mortality. Secondary objectives included investigating the predictors of ICU mortality and hospital overall survival (OS). All patients with GI cancer admitted to the ICU at the University of Texas MD Anderson Cancer Center between November 2012 and February 2015 were retrospectively analyzed. Cancer characteristics, treatment characteristics, and Sequential Organ Failure Assessment (SOFA) scores were analyzed for their effects on survival.
Results: The characteristics of the 200 patients were as follows: 64.5% male, mean age of 60 years, median SOFA score of 6.7, and tumor types of intestinal (37.5%), hepatobiliary/pancreatic (36%), and gastroesophageal (24%). The hospital mortality was 41%, and overall 6-month mortality was 75%. In multivariate analysis, high admission SOFA score > 5, poor tumor differentiation, and duration of metastatic disease ≤7 months were associated with increased hospital mortality. For OS, high admission SOFA score > 5, poor tumor differentiation, and patients who were not on active chemotherapy because of poor performance had worse outcome. In multivariate analysis, SOFA score remained significant for OS even after excluding patients who died in the ICU.
Conclusion: For patients with metastatic GI cancer admitted to the ICU, SOFA score was predictive for both acute and long-term survival. A patient's chemotherapy treatment status was not predictive for hospital mortality but was for OS. The SOFA score should be utilized in all patients with GI cancer upon ICU admission for prognostication.
Implications for practice: Patients with cancer have a high use of health care utilization at the end of life, which can frequently involve admissions to the intensive care unit (ICU). Although there have been substantial increases in duration of survival for patients with advanced metastatic cancer, their mortality after an ICU admission remains high. GI malignancy is considered one of the top three lethal cancers estimated in 2017. Survival of critically ill patients with advanced GI cancer should be evaluated to help guide treatment planning.
摘要
背景。癌症患者在临终时使用卫生保健服务的频率较高，这可能涉及频繁地入住重症监护室 (ICU)。我们试图评估因非手术病症入住 ICU 的胃肠 (GI) 癌患者的预后预测因子。
患者和方法。主要目标为确定医院死亡率的预测因子。次要目标包括调查 ICU 死亡率和医院总生存期(OS)的预测因子。对在 2012 年 11 月至 2015 年 2 月期间入住德州大学安德森癌症中心 (University of Texas MD Anderson Cancer Center) ICU 的所有GI癌患者进行回顾性分析。对癌症特征、治疗特征和序贯器官衰竭估计 (SOFA) 评分进行分析，以了解它们对生存期的影响。
结果。200 名患者的特征如下:64.5% 为男性，平均年龄为 60 岁，中位 SOFA 评分为 6.7，肿瘤类型为肠道肿瘤 (37.5%)、肝胆/胰腺肿瘤 (36%) 和胃食管肿瘤 (24%)。医院死亡率为 41%，总体 6 个月死亡率为 75%。在多变量分析中，入院高 SOFA 评分 > 5、肿瘤分化差以及转移性疾病持续时间 ≤7 个月均与医院死亡率升高相关。对于 OS，入院高 SOFA 评分 > 5，肿瘤分化差以及因体能状态差而未能进行积极化疗的患者具有较差的预后。在多变量分析中，即使排除在 ICU 中死亡的患者之后，SOFA 评分对 OS 而言仍然十分重要。
结论。对于入住 ICU 的转移性 GI 癌患者，SOFA 评分可以预测急性和长期存活。患者的化疗状态不能预测医院死亡率，但可以预测 OS。在入住 ICU 时，应对所有 GI 癌患者采用 SOFA 评分，以便进行预后预测。
实践意义:癌症患者在临终时使用卫生保健服务的频率较高，这可能涉及频繁地入住重症监护室 (ICU)。尽管晚期转移癌患者的生存期已大幅提高，但是，他们在入住 ICU 之后的死亡率仍然很高。据 2017 年预测，GI 恶性肿瘤被人们看作是三大致命性癌症之一。为了帮助指导治疗规划，应对生命垂危的晚期 GI 癌患者的生存期进行评估。
Keywords: Gastrointestinal cancers; ICU outcomes; Prognosis; SOFA score; Survival.
© AlphaMed Press 2018.