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Inicio Medicina Clínica (English Edition) Characteristics and outcome of patients with solid tumour requiring admission to...
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Vol. 153. Issue 7.
Pages 270-275 (October 2019)
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Vol. 153. Issue 7.
Pages 270-275 (October 2019)
Original article
DOI: 10.1016/j.medcle.2019.01.031
Characteristics and outcome of patients with solid tumour requiring admission to the intensive care unit. Usefulness of three severity score systems
Características y evolución de los pacientes con tumores sólidos que requieren ingreso en la unidad de cuidados intensivos. Utilidad de 3 escalas de gravedad
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María Lucía Pérez Péreza, Ana Gonzaga Lópezb, Bárbara Balandín Morenoa,
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balandinmoreno@gmail.com

Corresponding author.
, Constanza Maximiano Alonsoc, Diego Palacios Castañedaa, José Ferreres Francod, Javier García Sanza, Héctor Villanueva Fernándeza, Miguel Valdivia de la Fuentea, Alfonso Ortega Lópeza, Sara Alcántara Carmonaa, Marina Pérez Redondoa, Ana Royuela Vicentee
a Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
b Servicio de Oncología Médica, Hospital General Universitario de Elda, Alicante, Spain
c Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
d Servicio de Medicina Intensiva, Hospital Clínico de Valencia, Valencia, Spain
e Unidad de Bioestadística, Instituto de Investigación Sanitaria Puerta de Hierro Majadahonda, Madrid, Spain
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Tables (3)
Table 1. Characteristics of the patients with solid tumours admitted at intensive care unit.
Table 2. Predictive factors of hospital mortality of patients with solid tumours admitted at intensive care unit.
Table 3. Evaluation of the severity scores for prediction of mortality.
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Abstract
Background and objective

To describe the characteristics and the evolution of patients with solid tumours admitted to the ICU and to identify factors associated with hospital mortality and to evaluate three illness severity scores.

Material and methods

Descriptive study including 132 patients with solid tumour admitted to the ICU (2010–2016). Demographics and cancer-related data, organ failures, life-supporting therapies and severity scores: APACHE II, SOFA and ICU Cancer Mortality Model (ICMM) were collected.

Results

There were 58 patients admitted for medical reasons and 74 for scheduled surgery. The ICU and hospital mortality rate were 12.9% and 19.7%, respectively. The medical reason for admission, the number of organ failures, and the need of life-supporting therapies were significantly associated with a higher mortality (p<0.05). In the logistic regression analysis, the three severity scores: SOFA (OR 1.18, 95% IC 1.14–1.48), APACHE II (OR 1.11, 95% CI 1.09–1.27), and ICMM (OR 1.03, 95% CI 1.02–1.07) were independently associated with a higher mortality (p<0.05). To evaluate the discrimination, the area under the receiver operating characteristics curves (AUROC) were calculated: APACHE II (0.795, 95% CI 0.69–0.9), SOFA (0.77, 95% CI 0.69–0.864) and ICMM (0.794, 95% CI 0.697–0.891). The comparison of AUC ROC after DeLong's test showed no difference between them.

Conclusion

Hospital mortality was associated with the type and severity of acute illness. The three severity scores were useful to assess outcome and accurate in the discrimination, but we did not find a significant difference between them.

Keywords:
ICU
Solid tumour
Mortality
Severity illness score
Prognosis
Resumen
Introducción y objetivo

Describir las características generales y la evolución de los pacientes con tumores sólidos ingresados en una unidad de cuidados intensivos (UCI), identificar los factores asociados a la mortalidad y evaluar el valor pronóstico de 3 escalas de gravedad.

Material y métodos

Estudio descriptivo de 132 pacientes con diagnóstico de tumour sólido admitidos en la UCI (2010-2016). Se analizaron los datos demográficos relacionados con el tumour, la disfunción orgánica y las terapias de soporte vital, así como las escalas de gravedad APACHE II, SOFA e ICMM.

Resultados

Ingresaron 58 pacientes por causa médica y 74 tras cirugía programada. La tasa de mortalidad en la UCI y hospitalaria fue del 12,9% y 19,7%, respectivamente. La causa médica de ingreso, el número de fallos orgánicos y la necesidad de terapias de soporte vital se asociaron significativamente con mayor mortalidad (p<0,05). En el análisis por regresión logística las 3 escalas evaluadas: SOFA (OR: 1,18; IC 95%: 1,14-1,48), APACHE II (OR: 1,11; IC 95%: 1,09-1,27) e ICMM (OR: 1,03; IC 95%: 1,02-1,07) se asociaron de forma independiente con una mayor mortalidad (p<0,05). Para evaluar la discriminación, se calcularon las AUROC: APACHE II (0,795; CI 95%: 0,69-0,9), SOFA (0,77; CI 95%: 0,69-0,864) e ICMM (0,794; CI 95%: 0,697-0,891). La comparación de las mismas por el test DeLong no mostró diferencias entre los sistemas de puntuación.

Conclusiones

La mortalidad hospitalaria se asoció con el tipo y la gravedad de la enfermedad aguda. Las e escalas de gravedad evaluadas fueron igualmente útiles para evaluar el pronóstico, sin mostrar diferencias entre ellas.

Palabras clave:
Unidad de cuidados intensivos
Tumour sólido
Mortalidad
Escalas de gravedad
Pronóstico

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