Cancer-Related Characteristics Associated With Invasive Mechanical Ventilation or In-Hospital Mortality in Patients With COVID-19 Admitted to ICU: A Cohort Multicenter Study.

BACKGROUND: Coexistence of cancer and COVID-19 is associated with worse outcomes. However, the studies on cancer-related characteristics associated with worse COVID-19 outcomes have shown controversial results. The objective of the study was to evaluate cancer-related characteristics associated with invasive mechanical ventilation use or in-hospital mortality in patients with COVID-19 admitted to intensive care unit (ICU). METHODS: We designed a cohort multicenter study including adults with active cancer admitted to ICU due to COVID-19. Seven cancer-related characteristics (cancer status, type of cancer, metastasis occurrence, recent chemotherapy, recent immunotherapy, lung tumor, and performance status) were introduced in a multilevel logistic regression model as first-level variables and hospital was introduced as second-level variable (random effect). Confounders were identified using directed acyclic graphs. RESULTS: We included 274 patients. Required to undergo invasive mechanical ventilation were 176 patients (64.2%) and none of the cancer-related characteristics were associated with mechanical ventilation use. Approximately 155 patients died in hospital (56.6%) and poor performance status, measured with the Eastern Cooperative Oncology Group (ECOG) score was associated with increased in-hospital mortality, with odds ratio = 3.54 (1.60-7.88, 95% CI) for ECOG =2 and odds ratio = 3.40 (1.60-7.22, 95% CI) for ECOG = 3 to 4. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with in-hospital mortality. CONCLUSIONS: In patients with active cancer and COVID-19 admitted to ICU, poor performance status was associated with in-hospital mortality but not with mechanical ventilation use. Cancer status, cancer type, metastatic tumor, lung cancer, and recent chemotherapy or immunotherapy were not associated with invasive mechanical ventilation use or in-hospital mortality.

Characteristics and short-term outcomes of patients with esophageal cancer with unplanned intensive care unit admissions: a retrospective cohort study. / Características e desfechos em curto prazo de pacientes com câncer esofágico em admissões não planejadas a unidades de terapia intensiva: um estudo de coorte retrospectiva.

OBJECTIVE: To depict the clinical presentation and outcomes of a cohort of critically ill patients with esophageal cancer. METHODS: We carried out a multicenter retrospective study that included patients with esophageal cancer admitted to intensive care units with acute illness between September 2009 and December 2017. We collected the demographic and clinical characteristics of all included patients, as well as organ-support measures and hospital outcomes. We performed logistic regression analysis to identify independent factors associated with in-hospital mortality. RESULTS: Of 226 patients included in the study, 131 (58.0%) patients died before hospital discharge. Squamous cell carcinoma was more frequent than adenocarcinoma, and 124 (54.9%) patients had metastatic cancer. The main reasons for admission were sepsis/septic shock and acute respiratory failure. Mechanical ventilation (OR = 6.18; 95%CI 2.86 - 13.35) and metastatic disease (OR = 7.10; 95%CI 3.35 - 15.05) were independently associated with in-hospital mortality. CONCLUSION: In this cohort of patients with esophageal cancer admitted to intensive care units with acute illness, the in-hospital mortality rate was very high. The requirement for invasive mechanical ventilation and metastatic disease were independent prognostic factors and should be considered in discussions about the short-term outcomes of these patients.

Características e desfechos em curto prazo de pacientes com câncer esofágico em admissões não planejadas a unidades de terapia intensiva: um estudo de coorte retrospectiva / Characteristics and short-term outcomes of patients with esophageal cancer with unplanned intensive care unit admissions: a retrospective cohort study

RESUMO Objetivo: Mostrar o quadro clínico e os desfechos de uma coorte de pacientes críticos com câncer esofágico. Métodos: Conduzimos um estudo multicêntrico retrospectivo que incluiu pacientes com câncer esofágico admitidos a unidades de terapia intensiva em razão de doença aguda entre setembro de 2009 e dezembro de 2017. Colhemos os dados demográficos e as características clínicas de todos os pacientes incluídos, assim como as medidas de suporte a órgãos e os desfechos no hospital. Realizamos uma análise de regressão logística para identificar os fatores associados de forma independente com mortalidade hospitalar. Resultados: Dentre os 226 pacientes incluídos no estudo, 131 (58,0%) faleceram antes de receber alta hospitalar. O carcinoma espinocelular foi mais frequente do que o adenocarcinoma, e 124 (54,9%) pacientes tinham câncer metastático. As principais razões para admissão foram sepse/choque séptico e insuficiência respiratória aguda. Uso de ventilação mecânica (RC = 6,18; IC95% 2,86 - 13,35) e doença metastática (RC = 7,10; IC95% 3,35 - 15,05) tiveram associação independente com mortalidade hospitalar. Conclusão: Nesta coorte de pacientes com câncer esofágico admitidos à unidades de terapia intensiva em razão de doença aguda, a taxa de mortalidade hospitalar foi muito elevada. A necessidade de utilizar ventilação mecânica invasiva e a presença de doença metastática foram fatores independentes de prognóstico e devem ser levados em conta nas discussões a respeito dos desfechos destes pacientes em curto prazo.

ABSTRACT Objective: To depict the clinical presentation and outcomes of a cohort of critically ill patients with esophageal cancer. Methods: We carried out a multicenter retrospective study that included patients with esophageal cancer admitted to intensive care units with acute illness between September 2009 and December 2017. We collected the demographic and clinical characteristics of all included patients, as well as organ-support measures and hospital outcomes. We performed logistic regression analysis to identify independent factors associated with in-hospital mortality. Results: Of 226 patients included in the study, 131 (58.0%) patients died before hospital discharge. Squamous cell carcinoma was more frequent than adenocarcinoma, and 124 (54.9%) patients had metastatic cancer. The main reasons for admission were sepsis/septic shock and acute respiratory failure. Mechanical ventilation (OR = 6.18; 95%CI 2.86 - 13.35) and metastatic disease (OR = 7.10; 95%CI 3.35 - 15.05) were independently associated with in-hospital mortality. Conclusion: In this cohort of patients with esophageal cancer admitted to intensive care units with acute illness, the in-hospital mortality rate was very high. The requirement for invasive mechanical ventilation and metastatic disease were independent prognostic factors and should be considered in discussions about the short-term outcomes of these patients.

Características e evolução dos pacientes com câncer de esôfago admitidos em Unidade de Terapia Intensiva / Characteristics and outcomes of esophageal cancer patients admitted to intensive care unit

ntrodução: O câncer é responsável por mais de 12% de todas as causas de morte no mundo. No Brasil, mais de 15% dos pacientes admitidos em unidade de terapia intensiva (UTI) tem um diagnóstico de base de câncer. O câncer de esôfago possui um prognóstico ruim, com taxa de sobrevivência menor que 20% após cinco anos. Entretanto, as características e a evolução de pacientes com câncer de esôfago admitidos em UTI ainda não foi adequadamente estudada. Objetivo: Descrever o perfil dos pacientes com câncer de esôfago admitidos na UTI do A.C.Camargo Cancer Center em um período de 6 anos e identificar fatores de risco relacionados à mortalidade hospitalar destes pacientes, bem como dos subgrupos de pacientes admitidos por causas clínicas ou cirúrgicas de urgência e em pós-operatório (PO) de esofagectomia. Métodos: Estudo de coorte retrospectiva, onde foram coletados dados demográficos, motivos de admissão, estádio do câncer, gravidade à admissão da UTI, complicações relacionadas ao tumor (massa tumoral, fistula, obstrução e sangramento) e não relacionadas (disfunções orgânicas, infecções e complicações cardiovasculares) e mortalidade hospitalar. Uma análise multivariada por regressão logística incluindo variáveis pré-determinadas identificou os fatores independentemente associados à mortalidade hospitalar Resultados: Foram incluídos 272 pacientes, dos quais 100 (36,8%) faleceram à internação hospitalar. Tumores metastáticos (OR = 8,64; IC 95% 3,93-18,96), SAPS 3 (OR = 1,04; IC 95% 1,01-1,06), fibrilação atrial (FA) (OR = 2,95; IC 95% 1,11-7,85) e uso de vasopressor (OR = 2,31; IC 95% 1,03-5,16) foram fatores independentemente associados à mortalidade hospitalar. Dos 119 pacientes admitidos por causas clínicas ou cirurgia de urgência, 71 (59,7%) morreram à internação hospitalar. Os fatores independentemente associados à maior mortalidade hospitalar foram tumores metastáticos (OR = 9,26; IC 95% 2,84-30,21), ventilação mecânica (OR = 3,34; IC 95% 1,04-10,76), e SAPS 3 (OR = 1,03; IC 95% 0,85-1,24). Cento e seis pacientes foram admitidos no PO de esofagectomia, dos quais 17 (16%) não sobreviveram à internação. Deiscência de ferida, pneumonia, infecção de cateter, síndrome coronariana aguda, FA, delirium, uso de vasopressor e terapias de substituição renal foram mais comuns nos pacientes que faleceram. Conclusão: Pacientes com câncer de esôfago admitidos na UTI têm uma alta mortalidade. A presença de metástases, a gravidade inicial, FA e a necessidade de suporte às disfunções orgânicas associam-se à maior mortalidade hospitalar (AU)

Introduction: Cancer is the cause of 12% of deaths worldwide. More than 15% of patients admitted in intensive care units (ICU) in Brazil have a cancer diagnosis. Esophageal cancer has a dismal prognosis, with an overall survival of less than 20% in five years. However, the characteristics and outcomes of esophageal cancer patients admitted in ICU have not been adequately addressed. Objectives: To describe characteristics of esophageal patients admitted at A.C. Camargo Cancer Center during a six-year period, and to identify risk factors associated with hospital mortality in these patients, as well as in patients admitted for medical or urgent surgical reasons, and after esophagectomy. Methods: Retrospective cohort study. We collected demopgraphic data, reasons for admission, cancer status, severity at admission, tumor-related complications (tumor mass, fistula, obstruction and bleeding) and non-related complications (organ dysfunctions, infections and cardiovascular complications). A multivariate logistic regression analysis with a priori included variables identified independent factors associated with hospital mortality. Results: We included 272 patients, 100 (36,8%) of whom died during hospital stay. Metastatic tumors (OR = 8.64, CI 95% 3.93-18.96), SAPS 3 (OR = 1.04, CI 95% 1.01-1.06), atrial fibrillation (AF) (OR = 2.95, CI 95% 1.11-7.85) and vasopressor (OR = 2.31, CI 95% 1.03-5.16) were independently associated with hospital mortality. We included 119 patients admitted for medical or urgent surgical reasons, 71 (59,7%) of whom died. Metastatic tumors (OR = 9.26, CI 95% 2.84-30.21), mechanical ventilation (OR = 3.34, CI 95% 1.04-10.76) and SAPS 3 (OR = 1.03, CI 95% 1.07-1.12) were associated with hospital mortality. We included 106 patients after esophagectomy, 17 (16%) of whom died. Dehiscence, pneumonia, acute coronary syndrome, AF, delirium, vasopressor and renal replacement therapy were more common in patients who died. Conclusion: Esophahgeal cancer patients admitted in ICU have a high hospital mortality rate. Metastasis, initial severity, AF and organ-dysfunction support measures are associated with hospital mortality (AU)