Effect of Early Intervention on Long-Term Outcomes of Critically Ill Cancer Patients Admitted to ICUs*


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Abstract

Objectives:The objective of this observational study was to evaluate whether early intervention was associated with improved long-term outcomes in critically ill patients with cancer.Design:Retrospective analysis with prospectively collected data.Setting:A university-affiliated, tertiary referral hospital.Patients:Consecutive critically ill cancer patients who were managed by a medical emergency team before ICU admission between January 2010 and December 2012.Interventions:None.Measurements and Main Results:During the study period, 525 critically ill cancer patients were admitted to the ICU with respiratory failure (41.7%) and severe sepsis or septic shock (40.6%) following medical intervention by a medical emergency team. Of 356 ICU survivors, 161 (45.2%) received additional treatment for cancer after ICU discharge. Mortality was 66.1% at 6 months and 72.8% at 1 year. Median time from physiological derangement to intervention before ICU admission was significantly shorter in 1-year survivors (1.3 hr; interquartile range, 0.5–4.8 hr) than it was in nonsurvivors (2.9 hr; interquartile range, 0.8–9.6 hr) (p< 0.001). Additionally, the early intervention (≤ 1.5 hr) group had a lower 30-day mortality rate than the late intervention (> 1.5 hr) group (29.0% vs 55.3%; p < 0.001) and a similar difference in mortality rate was observed up to 1 year. Other factors associated with 1-year mortality were illness severity, performance status, malignancy status, presence of more than three abnormal physiological variables, time from derangement to ICU admission, and the need for mechanical ventilation. Even after adjusting for potential confounding factors, early intervention was significantly associated with 1-year mortality (adjusted hazard ratio, 0.456; 95% CI, 0.348–0.597; p < 0.001).Conclusion:Early intervention for clinical derangement on general wards was significantly associated with long-term outcomes in critically ill cancer patients.

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