Características clínicas y factores pronósticos de los pacientes con neoplasia de órgano sólido admitidos en la Unidad de Cuidados Intensivos

  1. Mula Martínez, Ramón
Supervised by:
  1. Juan Alfonso Soler Barnés Director
  2. José Luis Alonso Romero Director

Defence university: Universidad de Murcia

Fecha de defensa: 28 October 2024

Committee:
  1. Álvaro Rodríguez Lescure Chair
  2. Pedro Antonio Cascales Campos Secretary
  3. María Dolores Rodríguez Mulero Committee member

Type: Thesis

Sustainable development goals

Abstract

Introduction: Patients with solid organ tumors suffer from numerous serious pathologies, not always directly related to cancer. It is necessary to analyze the outcomes of this type of patients in the Intensive Care Unit (ICU) of the Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA), with the aim of improving clinical outcomes for this particular group of patients and optimizing available resources in their care. Objectives: To describe the clinical characteristics of patients with solid organ neoplasia upon admission to a tertiary level ICU. To identify hospital clinical evolution at six and twelve months. To identify prognostic factors for hospital mortality in patients admitted to the ICU. To describe the clinical characteristics of patients with solid organ tumors who are deemed unfit for ICU admission and compare clinical evolution at 28 days, three months, six months, and twelve months between admitted and unfit patients. Material and Methods: A unicentric, retrospective cohort study, selecting patients with solid organ tumors admitted to the ICU at HCUVA from January 2017 to December 2021. Additionally, patients consulted and deemed unfit for ICU admission during the same period were collected. Results: A total of 200 patients with solid organ neoplasia were admitted to the ICU. The average age was 61.6 ± 14.2 years. Seventy-seven percent had a good baseline status (ECOG 0-1). The most common neoplasias were digestive and hepatobiliary (24.5%). Thirty-eight percent were metastatic patients. The most frequent reasons for admission were neurological issues (26%), respiratory failure (24.5%), and sepsis (24%). The most commonly employed organ supports were invasive mechanical ventilation (47.5%) and noradrenaline (55.5%). ICU mortality was 32%, and hospital mortality was 42%. At six months, mortality was 51%, and at one year, it was 61%. Independent factors associated with higher mortality included prior oncological treatment (OR 2.31), the need for noradrenaline (OR 2.96), mechanical ventilation (OR 2.17), and the APACHE II score (OR 1.07). Higher albumin levels (OR 0.47) and ECOG 0-1 (OR 0.28) were protective factors for hospital mortality. Forty-seven patients with solid organ neoplasia were deemed unfit for ICU admission. Only 19% had a good baseline status (ECOG 0-1). Lung cancer was the most frequent neoplasia (29.8%). Fifty-nine point six percent were metastatic. The most common reason for consultation was respiratory failure (54.3%). Hospital mortality was 48.9%, at six months 66%, and at one year 74.5%. No differences were found at 28 days, three months, six months, or twelve months between patients who were admitted to the ICU and those who were deemed unfit. Conclusions: ICU admission for patients with solid organ neoplasia is justified, with a one-year survival rate of 39%. Survivors post-ICU admission do not suffer significant functional deterioration in the medium to long term, allowing more than half to continue their oncological treatment. The factors associated with hospital mortality identified in our sample included having received prior oncological treatment, the need for noradrenaline, mechanical ventilation, and the APACHE II score. Increased albumin levels and ECOG 0-1 were protective factors for hospital mortality. Mortality among admitted and deemed unfit patients in the ICU was similar in our series.