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Abstract
BackgroundIntensive care unit (ICU) readmission is generally associated with increased hospital stays and increased mortality. However, there are limited data on ICU readmission in critically ill cancer patients.MethodWe conducted a retrospective cohort study based on the prospective registry of all critically ill cancer patients admitted to the oncology medical ICU between January 2012 and December 2013. After excluding patients who were discharged to another hospital or decided to end-of-life care, we divided the enrolled patients into four groups according to the time period from ICU discharge to unexpected events (ICU readmission or ward death) as follows: no (without ICU readmission or death, n = 456), early (within 2 days, n = 42), intermediate (between 2 and 7 days, n = 64), and late event groups (after 7 days of index ICU discharge, n = 129). The independent risk factors associated with ICU readmission or unexpected death after ICU discharge were also analyzed using multinomial logistic regression model.ResultsThere were no differences in the reasons for ICU readmission across the groups. ICU mortality did not differ among the groups, but hospital mortality was significantly higher in the late event group than in the early event group. Mechanical ventilation during ICU stay, tachycardia, decreased mental status, and thrombocytopenia on the day of index ICU discharge increased the risk of early ICU readmission or unexpected ward death, while admission through the emergency room and sepsis and respiratory failure as the reasons for index ICU admission were associated with increased risk of late readmission or unexpected ward death. Interestingly, recent chemotherapy within 4 weeks before index ICU admission was inversely associated with the risk of late readmission or unexpected ward death.ConclusionIn critically ill cancer patients, patient characteristics predicting ICU readmission or unexpected ward death were different according to the time period between index ICU discharge and the events.
Highlights
The development of diagnostic and therapeutic modalities of cancer and improved clinical outcomes have caused an increase in the inflow of critically ill cancer patients to the intensive care unit (ICU) [1]
ICU mortality did not differ among the groups, but hospital mortality was significantly higher in the late event group than in the early event group
Mechanical ventilation during ICU stay, tachycardia, decreased mental status, and thrombocytopenia on the day of index ICU discharge increased the risk of early ICU readmission or unexpected ward death, while admission through the emergency room and sepsis and respiratory failure as the reasons for index ICU admission were associated with increased risk of late readmission or unexpected ward death
Summary
The development of diagnostic and therapeutic modalities of cancer and improved clinical outcomes have caused an increase in the inflow of critically ill cancer patients to the intensive care unit (ICU) [1]. Efforts have been made to identify the risk factors for ICU admission and mortality in cancer patients to improve their outcomes and to reduce the economic burden; there is limited data on unplanned ICU readmission and unexpected ward death after index ICU discharge in cancer patients, which is known to be associated with increased in-hospital mortality, length of hospital stay, and medical cost [4,5]. Previous studies that evaluated ICU readmission and unexpected ward death after ICU discharge have been performed in a general population of critically ill patients, not in cancer patients, and have defined ICU readmission and unexpected ward death as an event that occurred during the entire hospital stay period. There are limited data on ICU readmission in critically ill cancer patients
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