Plasma neutrophil gelatinase-associated lipocalin and factors related to acute kidney injury and mortality in critically ill cancer patients.

RATIONALE: Acute kidney injury (AKI) is a frequent complication in critically ill cancer patients. OBJECTIVES: To assess plasma neutrophil gelatinase-associated lipocalin (NGAL) levels and risks factors associated with AKI and mortality. METHODS: We recruited 96 critically ill cancer patients and followed them prospectively. Plasma NGAL levels were determined at intensive care unit (ICU) admission and at 48 hours. We generated receiver operating characteristic curves to assess the ability of NGAL to predict AKI. Logistic regression analysis was performed to determine risks factors associated with AKI. Cox-regression analysis was performed to evaluate 6-month mortality. MEASUREMENTS AND MAIN RESULTS: From 96 patients, 60 (63%) developed AKI and 33 (55%) were classified as stages 2 and 3. In patients without AKI at admission, plasma NGAL levels revealed an area under the curve (AUC) = 0.522 for all AKI stages and an AUC = 0.573 for stages 2 and 3 AKI (85% sensitivity and 67% specificity for a 50.66 ng/mL cutoff). We identified sequential organ failure assessment (SOFA) score (without renal parameters) at admission as an independent factor for developing stages 2 and 3 AKI, and haemoglobin as a protective factor. We observed that metastatic disease, dobutamine use and stage 3 AKI were independent factors associated with 6-month mortality. CONCLUSIONS: In our cohort of critically ill cancer patients, NGAL did not predict AKI. SOFA score was a risk factor for developing AKI, and haemoglobin level was a protective factor for developing AKI. The independent factors associated with 6-month mortality included metastatic disease, dobutamine use, lactate and stage 3 AKI.

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.

Clinical characteristics of critically ill cancer patients who are undergoing isolated limb perfusion.

The aim of the present study was to investigate the incidence of organ dysfunction, and to describe the clinical characteristics and intensive care unit (ICU) outcomes of critically ill cancer patients who were admitted to an oncological ICU during the isolated limb perfusion post-operative period. The present study was an observational investigation of 42 critically ill cancer patients who were admitted to the ICU of the Instituto Nacional de Cancerología, during the isolated limb perfusion post-operative period, between July 2010 and February 2016. The mean age of the patients was 45.7±16.9 years, and 45.2% (19 cases) were female. Soft tissue sarcoma was the most common pre-operative diagnosis (38.1%), and the mean duration of surgery was 267.6±50.1 min. Furthermore, a mean blood loss volume of 732.3±526.1 ml during the procedure was recorded, and the patients received a mean volume of 3.88±1.28 l crystalloid fluid during the surgical procedure, subsequently requiring an additional 2.95±6.28 l on the first post-operative day. The incidence of organ dysfunction was 90.5% and was most frequently noted in the respiratory (81%), hepatic (33%), hematologic (31%) and renal (11.9%) systems. No patients succumbed to the disease during the ICU and hospital stay. Nevertheless, <10% of the patients required vasopressors. Additionally, <5% of the patients required invasive mechanical ventilation. Therefore, ICU admission directly following isolated limb perfusion should not be standardized.

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.