Abstract
Original language | English |
---|---|
Journal | Clinical Sarcoma Research |
Volume | 6 |
DOIs | |
State | Published - 2016 |
Keywords
- Cancer Sarcoma ICU Survival SOFA critically-ill patients lung-cancer patients cardiopulmonary-resuscitation prognostic-factors outcomes score mortality admission Oncology
MD Anderson CCSG core facilities
- Biostatistics Resource Group
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In: Clinical Sarcoma Research, Vol. 6, 2016.
Research output: Contribution to journal › Meeting Abstract › peer-review
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TY - JOUR
T1 - Predictors of survival in patients with sarcoma admitted to the intensive care unit
T2 - Clinical Sarcoma Research
AU - Gupta, R.
AU - Heshami, N.
AU - Jay, C.
AU - Ramesh, N.
AU - Song, J.
AU - Lei, X. D.
AU - Rose, E. J.
AU - Carter, K.
AU - Araujo, D. M.
AU - Benjamin, R. S.
AU - Patel, S.
AU - Nates, J. L.
AU - Ravi, V.
N1 - ISI Document Delivery No.: DU0XM Times Cited: 0 Cited Reference Count: 31 Gupta, Rohan Heshami, Neda Jay, Chouhan Ramesh, Naveen Song, Juhee Lei, Xiudong Rose, Erfe Jean Carter, Kristen Araujo, Dejka M. Benjamin, Robert S. Patel, Shreyaskumar Nates, Joseph L. Ravi, Vinod Ramesh, Naveen/AAV-9919-2020 Ramesh, Naveen/0000-0003-1394-3529 Cancer Center Support Grant (NCI) [P30 CA016672]; NATIONAL CANCER INSTITUTEUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Cancer Institute (NCI) [P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, 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P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672, P30CA016672] Funding Source: NIH RePORTER We did not have any financial support. We thank critical care team for providing the initial data and SOFA scores. We thank statisticians Naveen Ramesh, Xiudong Lei and Juhee Song. The statistical analysis work was supported in part by the Cancer Center Support Grant (NCI Grant P30 CA016672). We thank scientific editors, Bryan Tutt and Tamara Locke, in Department of Scientific Publications at MD Anderson for manuscript editing 0 1 Bmc London 2045-3329
PY - 2016
Y1 - 2016
N2 - Background: Advances in treatment of sarcoma patients has prolonged survival but has led to increased disease-or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU). Survival and long-term outcome information about such critically ill patients with sarcoma is unknown. Methods: The primary objective of the study was to determine the ICU and post-ICU survival rates of critically ill sarcoma patients. Secondary objectives included determining the modifiable and non-modifiable predictors of poor survival. We performed a retrospective chart review of sarcoma patients admitted to the ICU at The University of Texas MD Anderson Cancer Center between January 1, 2005, and December 31, 2012. Main outcome measures were ICU mortality, in-hospital mortality and 1, 2, and 6-month survival rates. Covariates such as histological diagnosis, disease characteristics, chemotherapy use, Charlson comorbidity index, Sequential Organ Failure Assessment (SOFA) scores, and clinical findings leading to ICU admission were analyzed for their effects on survival. Results: We identified 172 admissions over the 8-year study period hat met our inclusion criteria. The study population was 45.9 % males with a median age of 52 years. The most common sarcoma subgroups were high-grade unclassified sarcoma (25 %) and bone tumors (17.4 %). The ICU mortality rate was 23.3 % (95 % confidence interval [CI], 16.9-29.6 %), and an additional 6.4 % of patients died before hospital discharge (95 % CI, 22.9-37.1 %). 6-month OS rates were 41 %. The median SOFA scores on admission were 6 (inter quartile range (IQR), 3.5-9) in ICU survivors and 10 (IQR, 6.5-14) in ICU non-survivors. Increase in SOFA scores = 6 led to poor outcomes (ICU survival 13.3 %, OS 6.7 %). Charlson comorbidity index (HR 1.139, 95 % CI 1.023-1.268, p = 0.02) and discharge SOFA scores (HR 1.210, 95 % CI 1.141-1.283, p <0.0001) correlated with overall survival. Conclusions: Our results suggest that patients that are admitted to the ICU for respiratory failure, cardiac arrest, septic shock, acute renal failure or acidosis and also have a high SOFA score with subsequent worsening in the ICU have poor prognosis. Based on the retrospective data which needs further validation we can recommend that judicious approach should be taken in patients with predictors of poor survival before subjecting them to aggressive treatment.
AB - Background: Advances in treatment of sarcoma patients has prolonged survival but has led to increased disease-or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU). Survival and long-term outcome information about such critically ill patients with sarcoma is unknown. Methods: The primary objective of the study was to determine the ICU and post-ICU survival rates of critically ill sarcoma patients. Secondary objectives included determining the modifiable and non-modifiable predictors of poor survival. We performed a retrospective chart review of sarcoma patients admitted to the ICU at The University of Texas MD Anderson Cancer Center between January 1, 2005, and December 31, 2012. Main outcome measures were ICU mortality, in-hospital mortality and 1, 2, and 6-month survival rates. Covariates such as histological diagnosis, disease characteristics, chemotherapy use, Charlson comorbidity index, Sequential Organ Failure Assessment (SOFA) scores, and clinical findings leading to ICU admission were analyzed for their effects on survival. Results: We identified 172 admissions over the 8-year study period hat met our inclusion criteria. The study population was 45.9 % males with a median age of 52 years. The most common sarcoma subgroups were high-grade unclassified sarcoma (25 %) and bone tumors (17.4 %). The ICU mortality rate was 23.3 % (95 % confidence interval [CI], 16.9-29.6 %), and an additional 6.4 % of patients died before hospital discharge (95 % CI, 22.9-37.1 %). 6-month OS rates were 41 %. The median SOFA scores on admission were 6 (inter quartile range (IQR), 3.5-9) in ICU survivors and 10 (IQR, 6.5-14) in ICU non-survivors. Increase in SOFA scores = 6 led to poor outcomes (ICU survival 13.3 %, OS 6.7 %). Charlson comorbidity index (HR 1.139, 95 % CI 1.023-1.268, p = 0.02) and discharge SOFA scores (HR 1.210, 95 % CI 1.141-1.283, p <0.0001) correlated with overall survival. Conclusions: Our results suggest that patients that are admitted to the ICU for respiratory failure, cardiac arrest, septic shock, acute renal failure or acidosis and also have a high SOFA score with subsequent worsening in the ICU have poor prognosis. Based on the retrospective data which needs further validation we can recommend that judicious approach should be taken in patients with predictors of poor survival before subjecting them to aggressive treatment.
KW - Cancer Sarcoma ICU Survival SOFA critically-ill patients lung-cancer patients cardiopulmonary-resuscitation prognostic-factors outcomes score mortality admission Oncology
U2 - 10.1186/s13569-016-0051-5
DO - 10.1186/s13569-016-0051-5
M3 - Meeting Abstract
C2 - 27437097
SN - 2045-3329
VL - 6
JO - Clinical Sarcoma Research
JF - Clinical Sarcoma Research
ER -