Elderly patients with cancer admitted to intensive care unit: A multicenter study in a middle-income country

by Antonio Paulo Nassar Junior, Mariane da Silva Trevisani, Barbara Beltrame Bettim, Fernando Godinho Zampieri, José Albani Carvalho Jr., Amilton Silva Jr., Flávio Geraldo Rezende de Freitas, Jorge Eduardo da Silva Soares Pinto, Edson Romano, Silvia Regina Ramos, Guilherme Brenande Alves Faria, Ulysses V. Andrade e Silva, Robson Correa Santos, Edmundo de Oliveira Tommasi, Ana Paula Pierre de Moraes, Bruno Azevedo da Cruz, Fernando Augusto Bozza, Pedro Caruso, Jorge Ibrahin Figueira Salluh, Marcio Soares

Background

Very elderly critically ill patients (ie, those older than 75 or 80 years) are an increasing population in intensive care units. However, patients with cancer have encompassed only a minority in epidemiological studies of very old critically-ill patients. We aimed to describe clinical characteristics and identify factors associated with hospital mortality in a cohort of patients aged 80 or older with cancer admitted to intensive care units (ICUs).

Methods

This was a retrospective cohort study in 94 ICUs in Brazil. We included patients aged 80 years or older with active cancer who had an unplanned admission. We performed a mixed effect logistic regression model to identify variables independently associated with hospital mortality.

Results

Of 4604 included patients, 1807 (39.2%) died in hospital. Solid metastatic (OR = 2.46; CI 95%, 2.01–3.00), hematological cancer (OR = 2.32; CI 95%, 1.75–3.09), moderate/severe performance status impairment (OR = 1.59; CI 95%, 1.33–1.90) and use of vasopressors (OR = 4.74; CI 95%, 3.88–5.79), mechanical ventilation (OR = 1.54; CI 95%, 1.25–1.89) and renal replacement (OR = 1.81; CI 95%, 1.29–2.55) therapy were independently associated with increased hospital mortality. Emergency surgical admissions were associated with lower mortality compared to medical admissions (OR = 0.71; CI 95%, 0.52–0.96).

Conclusions

Hospital mortality rate in very elderly critically ill patients with cancer with unplanned ICU admissions are lower than expected a priori. Cancer characteristics, performance status impairment and acute organ dysfunctions are associated with increased mortality.