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Outcome of Critically Ill Patients With Testicular Cancer Admitted to the ICU
Critical Care SESSION TITLE: Miscellaneous Critical Care SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM
Outcome of Critically Ill Patients With Testicular Cancer Admitted to the ICU Silvio Ñamendys-Silva MD* Francisco Garcia-Guillen MD Bertha Córdova-Sánchez MD Edgar ConstantinoHérnandez MD Andoreni Bautista-Ocampo MD Mireya Barragan-Dessavre MD Paulina Correa-García MD; and Angel Herrera-Gómez MD Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico PURPOSE: To evaluate the clinical characteristics and hospital outcomes of critically ill patients with testicular cancer (TC) admitted to an oncological intensive care unit (ICU). METHODS: Prospective observational study from February 2008 to February 2015 in the ICU of the Instituto Nacional de Cancerologia (INCan) located in Mexico City. There were no interventions. Sixty patients with TC were admitted to the ICU. Continuous variables are expressed as means standard deviation or as medians and interquartile ranges. Categorical variables are expressed as percentage. Student’s t-test or the Mann-Whitney U-test were used to compare continuous variables, and the chisquared or Fisher’s exact test was used to compare categorical variables. Cox proportional hazards univariate and multivariate analysis were used to identify factors with potential prognostic significance with 6-month survival. Results were reported using hazard ratios (HRs) and corresponding 95% confidence interval (CI). A two-sided P-value <0.05 was used to determine statistical significance.
CONCLUSIONS: The ICU, hospital, and 6-month rates were 38.3, 45, and 63.3%, respectively. The factors associated with increased 6-month mortality rate were the white blood cells count, the ionized calcium, and 2 or more organ failure during the first 24 hours after ICU admission. CLINICAL IMPLICATIONS: The results of this study suggest that 6-month mortality rates in critically ill patients with TC depends primarily on the number of organ dysfunctions, especially when 2 or more organs are affected. The ICU should be involved with prevention, early detection and early treatment of organ dysfunction. Aggressive early supportive treatment could reduce the impact of organ dysfunctions on mortality. DISCLOSURE: The following authors have nothing to disclose: Silvio Ñamendys-Silva, Francisco Garcia-Guillen, Bertha Córdova-Sánchez, Edgar Constantino-Hérnandez, Andoreni Bautista-Ocampo, Mireya Barragan-Dessavre, Paulina CorreaGarcía, Angel Herrera-Gómez No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.348
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
335A
CRITICAL CARE
RESULTS: During the study period, 60 patients with TC were admitted to the ICU of the INCan. The mean age of the patients was 28.3 8.2 years. The most common histologic type was non-seminomatous germ cell tumors (91.7%). Forty-nine patients (81.7%) were classified as having a poor prognosis, 9 patients (15%) as intermediate prognosis and 2 patients (3.3%) as good prognosis. During the first 24 hours of ICU admission, invasive mechanical ventilation was required by 43 patients (71.6%) for a median duration of 3 days (interquartile range, 1-7), and vasopressors were required by 27 patients (24%). The median length of stay in the hospital wards before ICU admission was 2 days (1-7). The length of stay in the ICU and hospital were 3 (2-6) and 8 (5-15) days, respectively. The ICU, hospital, and 6-month mortality rates were 38.3, 45, and 63.3%, respectively. Cox multivariate analysis identified the white blood cells count (HR¼1.06, 95%CI¼1.01-1.11, P¼0.005), ionized calcium (HR¼1.23, 95% CI¼1.01-1.50, P¼0.037), and 2 or more organ failure during the first 24 hours after ICU admission (HR¼3.86, 95%CI ¼ 1.96-7.59, P<0.001) as independent predictors of death to 6 months.
Outcome of Critically Ill Patients With Testicular Cancer Admitted to the ICU Silvio Ñamendys-Silva MD* Francisco Garcia-Guillen MD Bertha Córdova-Sánchez MD Edgar ConstantinoHérnandez MD Andoreni Bautista-Ocampo MD Mireya Barragan-Dessavre MD Paulina Correa-García MD; and Angel Herrera-Gómez MD Department of Critical Care Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico PURPOSE: To evaluate the clinical characteristics and hospital outcomes of critically ill patients with testicular cancer (TC) admitted to an oncological intensive care unit (ICU). METHODS: Prospective observational study from February 2008 to February 2015 in the ICU of the Instituto Nacional de Cancerologia (INCan) located in Mexico City. There were no interventions. Sixty patients with TC were admitted to the ICU. Continuous variables are expressed as means standard deviation or as medians and interquartile ranges. Categorical variables are expressed as percentage. Student’s t-test or the Mann-Whitney U-test were used to compare continuous variables, and the chisquared or Fisher’s exact test was used to compare categorical variables. Cox proportional hazards univariate and multivariate analysis were used to identify factors with potential prognostic significance with 6-month survival. Results were reported using hazard ratios (HRs) and corresponding 95% confidence interval (CI). A two-sided P-value <0.05 was used to determine statistical significance.
CONCLUSIONS: The ICU, hospital, and 6-month rates were 38.3, 45, and 63.3%, respectively. The factors associated with increased 6-month mortality rate were the white blood cells count, the ionized calcium, and 2 or more organ failure during the first 24 hours after ICU admission. CLINICAL IMPLICATIONS: The results of this study suggest that 6-month mortality rates in critically ill patients with TC depends primarily on the number of organ dysfunctions, especially when 2 or more organs are affected. The ICU should be involved with prevention, early detection and early treatment of organ dysfunction. Aggressive early supportive treatment could reduce the impact of organ dysfunctions on mortality. DISCLOSURE: The following authors have nothing to disclose: Silvio Ñamendys-Silva, Francisco Garcia-Guillen, Bertha Córdova-Sánchez, Edgar Constantino-Hérnandez, Andoreni Bautista-Ocampo, Mireya Barragan-Dessavre, Paulina CorreaGarcía, Angel Herrera-Gómez No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.348
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
335A
CRITICAL CARE
RESULTS: During the study period, 60 patients with TC were admitted to the ICU of the INCan. The mean age of the patients was 28.3 8.2 years. The most common histologic type was non-seminomatous germ cell tumors (91.7%). Forty-nine patients (81.7%) were classified as having a poor prognosis, 9 patients (15%) as intermediate prognosis and 2 patients (3.3%) as good prognosis. During the first 24 hours of ICU admission, invasive mechanical ventilation was required by 43 patients (71.6%) for a median duration of 3 days (interquartile range, 1-7), and vasopressors were required by 27 patients (24%). The median length of stay in the hospital wards before ICU admission was 2 days (1-7). The length of stay in the ICU and hospital were 3 (2-6) and 8 (5-15) days, respectively. The ICU, hospital, and 6-month mortality rates were 38.3, 45, and 63.3%, respectively. Cox multivariate analysis identified the white blood cells count (HR¼1.06, 95%CI¼1.01-1.11, P¼0.005), ionized calcium (HR¼1.23, 95% CI¼1.01-1.50, P¼0.037), and 2 or more organ failure during the first 24 hours after ICU admission (HR¼3.86, 95%CI ¼ 1.96-7.59, P<0.001) as independent predictors of death to 6 months.