Abstract
BackgroundAdvances in treatment of sarcoma patients has prolonged survival but has led to increased disease- or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU). Survival and long-term outcome information about such critically ill patients with sarcoma is unknown.MethodsThe primary objective of the study was to determine the ICU and post-ICU survival rates of critically ill sarcoma patients. Secondary objectives included determining the modifiable and non-modifiable predictors of poor survival. We performed a retrospective chart review of sarcoma patients admitted to the ICU at The University of Texas MD Anderson Cancer Center between January 1, 2005, and December 31, 2012. Main outcome measures were ICU mortality, in-hospital mortality and 1, 2, and 6-month survival rates. Covariates such as histological diagnosis, disease characteristics, chemotherapy use, Charlson comorbidity index, Sequential Organ Failure Assessment (SOFA) scores, and clinical findings leading to ICU admission were analyzed for their effects on survival.ResultsWe identified 172 admissions over the 8-year study period hat met our inclusion criteria. The study population was 45.9 % males with a median age of 52 years. The most common sarcoma subgroups were high-grade unclassified sarcoma (25 %) and bone tumors (17.4 %). The ICU mortality rate was 23.3 % (95 % confidence interval [CI], 16.9–29.6 %), and an additional 6.4 % of patients died before hospital discharge (95 % CI, 22.9–37.1 %). 6-month OS rates were 41 %. The median SOFA scores on admission were 6 (inter quartile range (IQR), 3.5–9) in ICU survivors and 10 (IQR, 6.5–14) in ICU non-survivors. Increase in SOFA scores ≥6 led to poor outcomes (ICU survival 13.3 %, OS 6.7 %). Charlson comorbidity index (HR 1.139, 95 % CI 1.023–1.268, p = 0.02) and discharge SOFA scores (HR 1.210, 95 % CI 1.141–1.283, p < 0.0001) correlated with overall survival.ConclusionsOur results suggest that patients that are admitted to the ICU for respiratory failure, cardiac arrest, septic shock, acute renal failure or acidosis and also have a high SOFA score with subsequent worsening in the ICU have poor prognosis. Based on the retrospective data which needs further validation we can recommend that judicious approach should be taken in patients with predictors of poor survival before subjecting them to aggressive treatment.
Highlights
Advances in treatment of sarcoma patients has prolonged survival but has led to increased disease- or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU)
Patient characteristics We identified a total of 212 sarcoma admissions to the ICU at MD Anderson between January 1, 2005, and December 31, 2012
We used Sequential Organ Failure Assessment (SOFA) scores, which have been calibrated to predict ICU and in-hospital mortality rates in cancer patients by evaluating the combination of clinical conditions that lead to ICU admission [20,21,22,23]. We found out those patients who had high SOFA scores on admission did worse than patients with lower SOFA scores
Summary
Advances in treatment of sarcoma patients has prolonged survival but has led to increased disease- or treatment-related complications resulting in greater number of admissions to the intensive care unit (ICU). Advances in treatment may prolong survival but can lead to increased disease- or treatment-related complications requiring aggressive critical care. Due to the rarity of this class of tumors, the survival of critically ill sarcoma patients has not been well studied. The treatment of such patients requires a multidisciplinary approach, with coordination among oncologists, critical care physicians, consulting services, ancillary staff, and patients’ families. Some studies have shown that patients lacking predictors of poor survival outcomes are considered as good candidates for aggressive therapy [6,7,8]
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