SM-08 * NEURO-ONCOLOGICAL PATIENTS ADMITTED IN INTENSIVE-CARE UNIT (ICU): PATIENT'S CHARACTERISTICS, PREDICTIVE FACTORS OF DEATH IN ICU AND FUNCTIONAL OUTCOME

Abstract

BACKGROUND: Prognostic of oncological patients admitted in ICU is considered pejorative with a high mortality rate. To date, outcome of neuro-oncological patients admitted in ICU was never explored. Our objective was to analyze the characteristics, predictive factors of death in ICU and functional outcome after ICU for neuro-oncological patients. METHODS: Retrospective study of all patients with primary brain tumor admitted in our institutional ICU for medical indications between January 2002 and December 2012. Functional status was evaluated before first symptom associated to ICU admission and after ICU. Predictive impact on the risk of death in ICU was analyzed using the chi square test and the Mann-Whitney U-test. RESULTS: 71 patients were admitted in the ICU(≈3% of our patients); 22% died in ICU. Half of them had glioblastoma. ICU admission indications were mainly refractory seizures(41%) and septic shock(17%). At admission, 16% had multi-organ failure. Ventilation was necessary for 41%, catecholamines for 13%. 9% of patients received chemotherapy in ICU. Predictive factors associated to an increased risk of death in ICU were: non-neurological cause of admission(p = 0.022), multiple organ failures(p < 0.001), respiratory(p < 0.001), hemodynamic(p < 0.001), hepatic(p = 0.003) or renal dysfunction(p = 0.023). Longer delay between first symptom and ICU admission tended to increase this risk (p = 0.083). On the contrary, abnormal Glasgow score(p = 0.205) as well as tumor type(p = 0.678), tumor control status(p = 0.380) and number of previous lines(p = 0.409) were not associated to an increased risk of death in ICU. None of the patients receiving chemotherapy died in ICU. Among the 35 evaluable patients, 77% presented with a stable or improved Karnofsky Performance Status after ICU hospitalization as compared to ongoing status before ICU related disease. CONCLUSION: In patient with malignant brain tumor,admitted in ICU, predictive factors of death appear to be similar to those described in non-oncological patients. ICU hospitalization is generally not associated with a subsequent decrease of functional status.