PLoS ONE (Jan 2020)

Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country.

  • Antonio Paulo Nassar Junior,
  • Mariane da Silva Trevisani,
  • Barbara Beltrame Bettim,
  • Fernando Godinho Zampieri,
  • José Albani Carvalho,
  • Amilton Silva,
  • Flávio Geraldo Rezende de Freitas,
  • Jorge Eduardo da Silva Soares Pinto,
  • Edson Romano,
  • Silvia Regina Ramos,
  • Guilherme Brenande Alves Faria,
  • Ulysses V Andrade E Silva,
  • Robson Correa Santos,
  • Edmundo de Oliveira Tommasi,
  • Ana Paula Pierre de Moraes,
  • Bruno Azevedo da Cruz,
  • Fernando Augusto Bozza,
  • Pedro Caruso,
  • Jorge Ibrahin Figueira Salluh,
  • Marcio Soares

DOI
https://doi.org/10.1371/journal.pone.0238124
Journal volume & issue
Vol. 15, no. 8
p. e0238124

Abstract

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BackgroundVery elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs).MethodsThis was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality.ResultsOf 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01-3.00), hematological cancer (OR = 2.32; CI 95%, 1.75-3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33-1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88-5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25-1.89) and renal replacement (OR = 1.81; CI 95%, 1.29-2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52-0.96).ConclusionsHospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality.