Identification des facteurs de risque de mortalité à 30 jours des patients atteints d’un cancer solide hospitalisés en réanimation médicale ; description de leurs caractéristiques, de leur devenir et des réflexions éthiques entreprises pendant leur séjour

Abstract : Introduction: the decision to transfer patients with solid cancer tumours to an intensive care unit (ICU) is still controversial and difficult. Few studies have assessed the outcome for these patients. Objective: the aim of this study was to identify 30-day prognostic factors/mortality for patients with solid cancer tumours admitted to an ICU. Methods: we conducted a retrospective cohort study of all consecutive patients with solid cancer tumours admitted to ICUs at Bordeaux University Hospital, between January 2010 and December 2015. The study end point was 30-day mortality. Secondary end points were to describe the characteristics and outcomes for patients, and ethical practices. Results: we included 235 patients with solid tumors. Most of them were in a metastatic setting (60%).The most common causes for ICU admission were sepsis (56%) and/or respiratory failure (52%). ICU, 30-day, 90-day mortality rates were 24%, 36% and 50% respectively. After ICU stay, 44% of patients had restarted an anti- tumoral treatment. In multivariate analysis and after excluding SAPS 2 score, two or more organ failures (p = . 005) and being under non-curative care (p = .028) were independent prognostic factors of 30-day mortality. A support person was designated in 81% of cases, advance directives expressed in 2% and collective decision reported in 21%. Limitation of life-sustaining therapy was decided for 23% and 43% of pts before admission and during the ICU stay, respectively. Conclusion: the number of organ failures is a rapidly assessable variable that can help oncologists and intensive care specialists in their decision. A support person is often designated but advance directives are still unusual.

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https://dumas.ccsd.cnrs.fr/dumas-01978660
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Submitted on : Friday, January 11, 2019 - 4:23:59 PM
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Camille Baylot. Identification des facteurs de risque de mortalité à 30 jours des patients atteints d’un cancer solide hospitalisés en réanimation médicale ; description de leurs caractéristiques, de leur devenir et des réflexions éthiques entreprises pendant leur séjour. Médecine humaine et pathologie. 2018. ⟨dumas-01978660⟩

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