Usefulness of the qSOFA score for predicting hospital mortality in cancer patients.

BACKGROUND: The quick Sequential Sepsis-related Organ Failure Assessment (qSOFA) is a score that has been proposed to quickly identify patients at higher risk of death. OBJECTIVE: To describe the usefulness of the qSOFA score to predict in-hospital mortality in cancer patients. MATERIAL AND METHODS: Cross-sectional study carried out between January 2021 and December 2022. Hospital mortality was the dependent variable. The area under the ROC curve (AUC) was calculated to determine the discriminative ability of qSOFA to predict in-hospital mortality. RESULTS: A total of 587 cancer patients were included. A qSOFA score higher than 1 obtained a sensitivity of 57.2%, specificity of 78.5%, a positive predictive value of 55.4% and negative predictive value of 79.7%. The AUC of qSOFA for predicting in-hospital mortality was 0.70. In-hospital mortality of patients with qSOFA scores of 2 and 3 points was 52.7 and 64.4%, respectively. In-hospital mortality was 31.9% (187/587). CONCLUSION: qSOFA showed acceptable discriminative ability for predicting in-hospital mortality in cancer patients.

ANTECEDENTES: El quick Sequential Sepsis-related Organ Failure Assessment (qSOFA) es una puntuación propuesta para identificar de forma rápida a pacientes con mayor probabilidad de morir. OBJETIVO: Describir la utilidad de la puntuación qSOFA para predecir mortalidad hospitalaria en pacientes con cáncer. MATERIAL Y MÉTODOS: Estudio transversal realizado entre enero de 2021 y diciembre de 2022. La mortalidad hospitalaria fue la variable dependiente. Se calculó el área bajo la curva ROC (ABC) para determinar la capacidad discriminativa de qSOFA para predecir mortalidad hospitalaria. RESULTADOS: Se incluyeron 587 pacientes con cáncer. La puntuación qSOFA < 1 obtuvo una sensibilidad de 57.2 %, una especificidad de 78.5 %, un valor predictivo positivo de 55.4 % y un valor predictivo negativo de 79.7 %. El ABC de qSOFA para predecir mortalidad hospitalaria fue de 0.70. La mortalidad hospitalaria de los pacientes con qSOFA de 2 y 3 puntos fue de 52.7 y 64.4 %, respectivamente. La mortalidad hospitalaria fue de 31.9 % (187/587). CONCLUSIÓN: qSOFA mostró capacidad discriminativa aceptable para predecir mortalidad hospitalaria en pacientes con cáncer.

Access to Palliative Care for Critically Ill Cancer Patients in Mexico.

OBJECTIVE: To determine the outcomes of hospitalized cancer patients requiring intensive care unit (ICU) intervention and receiving palliative care. MATERIALS AND METHODS: An observational retrospective study was completed at a single academic critical care unit in Mexico City. All hospitalized cancer patients who were evaluated by the intensive care team to assess need for ICU were included between January and December 2018. RESULTS: During the study period, the ICU group made 408 assessments of critically ill cancer patients in noncritical hospitalized areas. In total, 24.2% (99/408) of the patients in this population were consulted by the palliative care team. Of the patients evaluated, 46.5% (190/408) had advanced stage, but only 28.4% were receiving care by the palliative care team. The only risk factor for hospital mortality in the multivariate analysis was the quick Sequential Organ Failure Assessment (qSOFA) score at the time of the consultation by the ICU group (HR = 2.10, 95% CI = 1.34-3.29, p = 0.001). The median time between palliative care consultation and death was 3 days (IQR = 2-22). A total of 63% (37/58) of patients who were discharged from the hospital died during follow-up. The median follow-up time was 55 days (95% CI = 26.9-83.0). The overall mortality rate for the entire group during hospitalization and after hospital discharge was 80.8% (80/99). CONCLUSION: Fewer than 3 out of 10 hospitalized cancer patients requiring admission to the ICU were evaluated by the palliative care team despite having incurable cancer. The qSOFA score of patients at the time of the ICU consultation was the only risk factor for mortality during hospitalization. Future research efforts in Mexico should focus on earlier integration of palliation care with usual oncology care in incurable cancer patients.

Outcomes of patients with COVID-19 in the intensive care unit in Mexico: A multicenter observational study.

BACKGROUND: As of June 15, 2020, a cumulative total of 7,823,289 confirmed cases of COVID-19 have been reported across 216 countries and territories worldwide. However, there is little information on the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to intensive care units (ICUs) in Latin America. The present study evaluated the clinical characteristics and outcomes of critically ill patients with severe COVID-19 who were admitted to ICUs in Mexico. METHODS: This was a multicenter observational study that included 164 critically ill patients with laboratory-confirmed COVID-19 who were admitted to 10 ICUs in Mexico, from April 1 to April 30, 2020. Demographic data, comorbid conditions, clinical presentation, treatment, and outcomes were collected and analyzed. The date of final follow-up was June 4, 2020. RESULTS: A total of 164 patients with severe COVID-19 were included in this study. The mean age of patients was 57.3 years (SD 13.7), 114 (69.5%) were men, and 6.0% were healthcare workers. Comorbid conditions were common in patients with critical COVID-19: 38.4% of patients had hypertension and 32.3% had diabetes. Compared to survivors, nonsurvivors were older and more likely to have diabetes, hypertension or other conditions. Patients presented to the hospital a median of 7 days (IQR 4.5-9) after symptom onset. The most common presenting symptoms were shortness of breath, fever, dry cough, and myalgias. One hundred percent of patients received invasive mechanical ventilation for a median time of 11 days (IQR 6-14). A total of 139 of 164 patients (89.4%) received vasopressors, and 24 patients (14.6%) received renal replacement therapy during hospitalization. Eighty-five (51.8%) patients died at or before 30 days, with a median survival of 25 days. Age (OR, 1.05; 95% CI, 1.02-1.08; p<0.001) and C-reactive protein levels upon ICU admission (1.008; 95% CI, 1.003-1.012; p<0.001) were associated with a higher risk of in-hospital death. ICU length of stay was associated with reduced in-hospital mortality risk (OR, 0.89; 95% CI, 0.84-0.94; p<0.001). CONCLUSIONS: This observational study of critically ill patients with laboratory-confirmed COVID-19 who were admitted to the ICU in Mexico demonstrated that age and C-reactive protein level upon ICU admission were associated with in-hospital mortality, and the overall hospital mortality rate was high. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04336345.

Incidence of Delirium in Critically Ill Cancer Patients.

Objective: The aim of this study was to estimate the incidence of delirium and its risk factors among critically ill cancer patients in an intensive care unit (ICU). Materials and Methods: This is a prospective cohort study. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was measured daily at morning to diagnose delirium by a physician. Delirium was diagnosed when the daily was positive during a patient's ICU stay. All patients were followed until they were discharged from the ICU. Using logistic regression, we estimated potential risk factors for developing delirium. The primary outcome was the development of ICU delirium. Results: There were 109 patients included in the study. Patients had a mean age of 48.6 ± 18.07 years, and the main reason for admission to the ICU was septic shock (40.4%). The incidence of delirium was 22.9%. The mortality among all subjects was 15.6%; the mortality rate in patients who developed delirium was 12%. The only variable that had an association with the development of delirium in the ICU was the days of use of mechanical ventilation (OR: 1.06; CI 95%: 0.99-1.13;p=0.07). Conclusion: Delirium is a frequent condition in critically ill cancer patients admitted to the ICU. The duration in days of mechanical ventilation is potential risk factors for developing delirium during an ICU stay. Delirium was not associated with a higher rate of mortality in this group of patients.

Outcome of Critically Ill Patients with Testicular Cancer.

PURPOSE: To evaluate the clinical characteristics and outcomes of critically ill patients with testicular cancer (TC) admitted to an oncological intensive care unit (ICU). METHODS: This was a prospective observational study. There were no interventions. RESULTS: During the study period, 1,402 patients with TC were admitted to the Department of Oncology, and 60 patients (4.3%) were admitted to the ICU. The most common histologic type was nonseminomatous germ cell tumors (55/91.7%). The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The Cox multivariate analysis identified the white blood cells count (HR = 1.06, 95% CI = 1.01-1.11, and P = 0.005), ionized calcium (iCa) level (HR = 1.23, 95% CI = 1.01-1.50, and P = 0.037), and 2 or more organ failures during the first 24 hours after ICU admission (HR = 3.86, 95% CI = 1.96-7.59, and P < 0.001) as independent predictors of death for up to 6 months. CONCLUSION: The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The factors associated with an increased 6-month mortality rate were white blood cells count, iCa level, and 2 or more organ failures during the first 24 hours after ICU admission.

Incidence of high body mass index in critically ill cancer patients.

OBJECTIVE: The aims of this study were to describe the incidence of obesity and overweight in critically ill cancer patients, and to evaluate the clinical characteristics and Intensive Care Unit (ICU) outcomes of critically ill cancer patients with obesity and overweight. METHODS: An observational cohort study. There were no interventions. RESULTS: During the study period, 483 critically ill cancer patients were admitted to ICU, and 59.2% of them (258 patients) had high body mass index (BMI). Comparing the groups of patients with BMI < 25 kg/m2 and ≥ 25 kg/m2, we observed that those with BMI ≥ 25 kg/m2 were older at the time of admission to the ICU. The global mortality in ICU was of 22.4%. ICU mortality was similar between patients with BMI < 25 kg/m2 and ≥ 25 kg/m2 (21.3% versus 23.0%, p = 0.649). Univariate analysis indicated that the following five factors were associated with ICU death in patients with BMI ≥ 25 kg/m2 as the outcome variable of interest: age, sepsis, invasive mechanical ventilation, type 2 diabetes, ≥ two organ failures. Multivariate analysis identified ≥ two organ failures as independent prognostic factor of ICU death. CONCLUSION: Critically ill cancer patients have a high incidence of high BMI; approximately six of every ten patients admitted to the ICU with a serious condition are overweight or show several degrees of obesity. The ICU mortality of the patients with a body mass index < 25 kg/m2 and ≥ 25 kg/m2 was similar. The independent prognostic factor of ICU death in critically ill patients with a BMI ≥ 25 kg/m2 was the number of organ dysfunctions, especially when two or more organs were affected.

Incidence of high body mass index in critically ill cancer patients / Incidencia de índice de masa corporal elevado en pacientes con cáncer críticamente enfermos

Objective: The aims of this study were to describe the incidence of obesity and overweight in critically ill cancer patients, and to evaluate the clinical characteristics and Intensive Care Unit (ICU) outcomes of critically ill cancer patients with obesity and overweight. Methods: An observational cohort study. There were no interventions. Results: During the study period, 483 critically ill cancer patients were admitted to ICU, and 59.2% of them (258 patients) had high body mass index (BMI). Comparing the groups of patients with BMI < 25 kg/m2 and ≥ 25 kg/m2, we observed that those with BMI ≥ 25 kg/m2 were older at the time of admission to the ICU. The global mortality in ICU was of 22.4%. ICU mortality was similar between patients with BMI < 25 kg/m2 and ≥ 25 kg/m2 (21.3% versus 23.0%, p = 0.649). Univariate analysis indicated that the following fi ve factors were associated with ICU death in patients with BMI ≥ 25 kg/m2 as the outcome variable of interest: age, sepsis, invasive mechanical ventilation, type 2 diabetes, ≥ two organ failures. Multivariate analysis identified ≥ two organ failures as independent prognostic factor of ICU death. Conclusion: Critically ill cancer patients have a high incidence of high BMI; approximately six of every ten patients admitted to the ICU with a serious condition are overweight or show several degrees of obesity. The ICU mortality of the patients with a body mass index < 25 kg/m2 and ≥ 25 kg/m2 was similar. The independent prognostic factor of ICU death in critically ill patients with a BMI ≥ 25 kg/m2 was the number of organ dysfunctions, especially when two or more organs were affected (AU)

Objetivo: Describir la incidencia de obesidad y sobrepeso en pacientes graves con cáncer y evaluar las características clínicas y el pronóstico de los pacientes oncológicos gravemente enfermos con sobrepeso y obesidad. Métodos: Estudio observacional y descriptivo. No se realizó ninguna intervención. Resultados: Durante el periodo de estudio, 483 pacientes graves con cáncer fueron ingresados a la unidad de cuidados intensivos (UCI); el 59.2% (258 pacientes) tuvo índice de masa corporal (IMC) elevado. Al comparar los pacientes con IMC < 25 kg/m2 y con IMC ≥ 25 kg/m2, se observó que los pacientes con IMC ≥ 25 kg/m2 eran de mayor edad al momento de ingresar en la UCI. La mortalidad en la UCI fue del 22.4%. La mortalidad fue similar en los grupos con IMC < 25 kg/m2 y ≥ 25 kg/m2 (21.3% versus 23.0%, p = 0.649). El análisis multivariado determinó que las siguientes variables fueron asociadas con muerte en la UCI en el grupo de pacientes con IMC ≥ 25 kg/m2: edad, sepsis, ventilación mecánica invasiva, diabetes mellitus tipo 2 y cursar con dos o más fallas orgánicas. El análisis multivariado identificó como factor pronóstico independiente para muerte en la UCI cursar con dos o más fallas orgánicas. Conclusión: los pacientes graves con cáncer tienen una alta incidencia de IMC elevado; aproximadamente seis de cada diez pacientes ingresados en la UCI con una condición que pone en peligro la vida tienen sobrepeso o son obesos. La mortalidad fue similar en los grupos con IMC < 25 kg/m2 y ≥ 25 kg/m2. En el grupo de pacientes con IMC ≥ 25 kg/m2 se identificó como factor pronóstico independiente para muerte en UCI el número de fallas orgánicas especialmente cuando dos o más órganos están afectados (AU)

Usefulness of ultrasonographic measurement of the diameter of the inferior vena cava to predict responsiveness to intravascular fluid administration in patients with cancer.

We conducted an observational, longitudinal prospective study in which we measured the diameters of the inferior vena cava (IVC) of 47 patients using ultrasonography. The aim of our study was to assess the state of blood volume and to determine the percentage of patients who responded to intravascular volume expansion. Only 17 patients (36%) responded to fluid management. A higher number of responding patients had cardiovascular failure compared with nonresponders (82% vs. 50%, P = 0.03). Among the patients with cardiovascular failure, the probability of finding responders was 4.6 times higher than that of not finding responders (odds ratio, 4.66; 95% confidence interval, 1.10-19.6; P = 0.04). No significant difference was observed in the mortality rate between the two groups (11% vs. 23%, P = 0.46). In conclusion, responding to intravascular volume expansion had no impact on patient survival in the intensive care unit.

Outcomes of critically ill cancer patients with Acinetobacter baumannii infection.

AIM: To describe the intensive care unit (ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii (AB) infection. METHODS: This was an observational study that included 23 consecutive cancer patients who acquired AB infections during their stay at ICU of the National Cancer Institute of Mexico (INCan), located in Mexico City. Data collection took place between January 2011, and December 2012. Patients who had AB infections before ICU admission, and infections that occurred during the first 2 d of ICU stay were excluded. Data were obtained by reviewing the electronic health record of each patient. This investigation was approved by the Scientific and Ethics Committees at INCan. Because of its observational nature, informed consent of the patients was not required. RESULTS: Throughout the study period, a total of 494 critically ill patients with cancer were admitted to the ICU of the INCan, 23 (4.6%) of whom developed AB infections. Sixteen (60.9%) of these patients had hematologic malignancies. Most frequent reasons for ICU admission were severe sepsis or septic shock (56.2%) and postoperative care (21.7%). The respiratory tract was the most frequent site of AB infection (91.3%). The most common organ dysfunction observed in our group of patients were the respiratory (100%), cardiovascular (100%), hepatic (73.9%) and renal dysfunction (65.2%). The ICU mortality of patients with 3 or less organ system dysfunctions was 11.7% (2/17) compared with 66.6% (4/6) for the group of patients with 4 or more organ system dysfunctions (P = 0.021). Multivariate analysis identified blood lactate levels (BLL) as the only variable independently associated with in-ICU death (OR = 2.59, 95%CI: 1.04-6.43, P = 0.040). ICU and hospital mortality rates were 26.1% and 43.5%, respectively. CONCLUSION: The mortality rate in critically ill patients with both HM, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a BLL ≥ 2.6 mmol/L in the first day of stay in the ICU.

Organ dysfunction in critically ill cancer patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

The aim of the present study was to observe the incidence of organ dysfunction and the intensive care unit (ICU) outcomes of critically ill cancer patients during the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy post-operative period. The present study included 25 critically ill cancer patients admitted to the ICU of the National Cancer Institute (Mexico City, Mexico) between January 2007 and February 2013. The incidence of organ dysfunction was 68% and patients exhibiting ≤1 organ system dysfunction during ICU admittance remained in hospital for a significantly shorter period compared with patients who exhibited ≥2 organ system dysfunctions (12.4±10.7 vs. 24.1±12.8 days; P=0.025). Therefore, the present study demonstrated that a high incidence of organ dysfunction was associated with a longer ICU hospital stay.

Tumor lysis syndrome in the emergency department: challenges and solutions.

Tumor lysis syndrome (TLS) is the most common oncologic emergency. It is caused by rapid tumor cell destruction and the resulting nucleic acid degradation during or days after initiation of cytotoxic therapy. Also, a spontaneous form exists. The metabolic abnormalities associated with this syndrome include hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and acute kidney injury. These abnormalities can lead to life-threatening complications, such as heart rhythm abnormalities and neurologic manifestations. The emergency management of overt TLS involves proper fluid resuscitation with crystalloids in order to improve the intravascular volume and the urinary output and to increase the renal excretion of potassium, phosphorus, and uric acid. With this therapeutic strategy, prevention of calcium phosphate and uric acid crystal deposition within renal tubules is achieved. Other measures in the management of overt TLS are prescription of hypouricemic agents, renal replacement therapy, and correction of electrolyte imbalances. Hyperkalemia should be treated quickly and aggressively as its presence is the most hazardous acute complication that can cause sudden death from cardiac arrhythmias. Treatment of hypocalcemia is reserved for patients with electrocardiographic changes or symptoms of neuromuscular irritability. In patients who are refractory to medical management of electrolyte abnormalities or with severe cardiac and neurologic manifestations, early dialysis is recommended.

Hypomagnesaemia in critically ill patients with haematological malignancies.

INTRODUCTION: There is currently little information regarding the incidence of hypomagnesaemia and its impact on the prognosis of critically ill patients with haematological malignancies. OBJECTIVE: This study sought to describe the incidence of hypomagnesaemia in critically ill patients with haematological malignancies admitted to an oncological intensive care unit (ICU). METHODS: A total of 102 critically ill patients with haematological malignancies, who were 18 years of age and admitted to the ICU between January 2008 and April 2011, were included in this study. Hypomagnesaemia was defined as a serum magnesium concentration below 1.7 mg/dl. RESULTS: The incidence of hypomagnesaemia at admission or during the first 24 hours of stay in the ICU was 22.5% (23/102). The hospital mortality rates of patients with and without hypomagnesaemia were 47.8% and 60.7%, respectively. CONCLUSION: The incidence of hypomagnesaemia in critically ill patients with haematological malignancies was 22.5%. Mortality in the ICU and in the hospital was similar in patients with and without hypomagnesaemia.

INTRODUCCIÓN: En la actualidad existe poca información relacionada con la incidencia de hipomagnesemia y su impacto en el pronóstico de pacientes hematológicos críticamente enfermos. OBJETIVO: Describir la incidencia de hipomagnesemia en pacientes hematológicos ingresados a en una unidad de cuidados intensivos (UCI) oncológica. MÉTODOS: Se incluyeron 102 pacientes con enfermedad hematológica, mayores de 18 años, ingresados en la UCI entre enero 2008 y abril 2011. Se definió hipomagnesemia como concentración sérica de magnesio inferior a 1,7 mg/dl. RESULTADOS: La incidencia de hipomagnesemia al ingreso o durante las primeras 24 horas de estancia en la UCI fue del 22,5% (23/102). La mortalidad hospitalaria de los enfermos con y sin hipomagnesemia fue del 47,8% y 60,7%, respectivamente. CONCLUSIÓN: La incidencia de hipomagnesemia en pacientes hematológicos críticamente enfermos fue del 22,5%. La mortalidad en UCI y en el hospital fue similar en los enfermos con y sin hipomagnesemia.

Hipomagnesemia en pacientes hematológicos críticamente enfermos / Hypomagnesaemia in critically ill patients with haematological malignancies

Introducción: En la actualidad existe poca información relacionada con la incidencia de hipomagnesemia y su impacto en el pronóstico de pacientes hematológicos críticamente enfermos. Objetivo: Describir la incidencia de hipomagnesemia en pacientes hematológicos ingresados a en una unidad de cuidados intensivos (UCI) oncológica. Métodos: Se incluyeron 102 pacientes con enfermedad hematológica, mayores de 18 años, ingresados en la UCI entre enero 2008 y abril 2011. Se definió hipomagnesemia como concentración sérica de magnesio inferior a 1,7 mg/dl. Resultados: La incidencia de hipomagnesemia al ingreso o durante las primeras 24 horas de estancia en la UCI fue del 22,5% (23/102). La mortalidad hospitalaria de los enfermos con y sin hipomagnesemia fue del 47,8% y 60,7%, respectivamente. Conclusión: La incidencia de hipomagnesemia en pacientes hematológicos críticamente enfermos fue del 22,5%. La mortalidad en UCI y en el hospital fue similar en los enfermos con y sin hipomagnesemia (AU)

Introduction: There is currently little information regarding the incidence of hypomagnesaemia and its impact on the prognosis of critically ill patients with haematological malignancies. Objective: This study sought to describe the incidence of hypomagnesaemia in critically ill patients with haematological malignancies admitted to an oncological intensive care unit (ICU). Methods: A total of 102 critically ill patients with haematological malignancies, who were 18 years of age and admitted to the ICU between January 2008 and April 2011, were included in this study. Hypomagnesaemia was defined as a serum magnesium concentration below 1.7 mg/dl. Results: The incidence of hypomagnesaemia at admission or during the first 24 hours of stay in the ICU was 22.5% (23/102). The hospital mortality rates of patients with and without hypomagnesaemia were 47.8% and 60.7%, respectively. Conclusion: The incidence of hypomagnesaemia in critically ill patients with haematological malignancies was 22.5%. Mortality in the ICU and in the hospital was similar in patients with and without hypomagnesaemia (AU)

Urgencias metabólicas en pacientes críticos con cáncer / Metabolic emergencies in critically ill cancer patients

Las alteraciones metabólicas graves que ocurren con frecuencia en pacientes oncológicos críticamente enfermos incluyen: hipercalcemia, hipocalcemia, hiponatremia, síndrome de lisis tumoral, alteraciones metabólicas asociadas a insuficiencia renal y acidosis láctica. Los enfermos oncológicos con urgencias metabólicas deben ser tratados en un departamento de oncología médica o en una unidad de cuidados intensivos. La mayor parte de las urgencias metabólicas se pueden tratar de forma adecuada cuando son identificadas de forma temprana. El clínico debe considerar, que el pronóstico de los pacientes oncológicos críticamente enfermos depende de su enfermedad primaria, las comorbilidades y las fallas orgánicas (AU)

Severe metabolic alterations frequently occur in critically ill cancer patients; hypercalcemia, hypocalcemia, hyponatremia, tumor lysis syndrome, metabolic complications of renal failure and lactic acidosis. Cancer patients with metabolic emergencies should be treated in a medical oncology department or an intensive care unit. Most metabolic emergencies can be treated properly when they are identified early. The clinician should consider that the prognosis of critically ill cancer patients depends on their primary disease, comorbidities and organ failure (AU)

Outcome of critically ill patients with hematological malignancies.

The prognosis for patients with hematological malignancies (HMs) admitted to the intensive care unit (ICU) is poor. The objective of this study was to evaluate the clinical characteristics and hospital outcomes of critically ill patients with HMs admitted to an oncological ICU. This is a prospective, observational cohort study. A total of 102 patients with HMs admitted to ICU from January 2008 to April 2011 were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality. During the study period, 3,776 patients with HM were admitted to the Department of Hematology of the Instituto Nacional de Cancerología located in Mexico City, Mexico. After being evaluated by the intensivist, 102 (2.68 %) patients were admitted to the ICU. The ICU mortality rates for patients who had two or less organ system failures and for those with three or more organ system dysfunctions were 20 % (5/25) and 70.1 % (54/77), respectively (P < 0.0001). A multivariate analysis identified independent prognostic factors of in-hospital death as neutropenia at the time of ICU admission (odds ratio (OR), 4.24; 95 % confidence interval (CI), 1.36-13.19, P = 0.012), the need for vasopressors (OR, 4.49; 95 % CI, 1.07-18.79, P = 0.040), need for invasive mechanical ventilation (OR, 4.49; 95 % CI, 1.07-18.79, P = 0.040), and serum creatinine >106 µmol/L (OR, 3.21; 95 % CI, 1.05-9.85, P = 0.041). The ICU and hospital mortality rates were 46.1 and 57.8 %, respectively. The independent prognostic factors of in-hospital death were the need for invasive mechanical ventilation, the need for vasopressors, serum creatinine >106 µmol/L, and neutropenia at the time of ICU admission.

[Metabolic emergencies in critically ill cancer patients]. / Urgencias metabolicas en pacientes criticos con cancer.

Severe metabolic alterations frequently occur in critically ill cancer patients; hypercalcemia, hypocalcemia, hyponatremia, tumor lysis syndrome, metabolic complications of renal failure and lactic acidosis. Cancer patients with metabolic emergencies should be treated in a medical oncology department or an intensive care unit. Most metabolic emergencies can be treated properly when they are identified early. The clinician should consider that the prognosis of critically ill cancer patients depends on their primary disease, comorbidities and organ failure.

Las alteraciones metabólicas graves que ocurren con frecuencia en pacientes oncológicos críticamente enfermos incluyen: hipercalcemia, hipocalcemia, hiponatremia, síndrome de lisis tumoral, alteraciones metabólicas asociadas a insuficiencia renal y acidosis láctica. Los enfermos oncológicos con urgencias metabólicas deben ser tratados en un departamento de oncología médica o en una unidad de cuidados intensivos. La mayor parte de las urgencias metabólicas se pueden tratar de forma adecuada cuando son identificadas de forma temprana. El clínico debe considerar, que el pronóstico de los pacientes oncológicos críticamente enfermos depende de su enfermedad primaria, las comorbilidades y las fallas orgánicas.