Changes in critically ill cancer patients' short-term outcome over the last decades: results of systematic review with meta-analysis on individual data
Por:
Darmon, M, Bourmaud, A, Georges, Q, Soares, M, Jeon, K, Oeyen, S, Rhee, CK, Gruber, P, Ostermann, M, Hill, QA, Depuydt, P, Ferra, C, Toffart, AC, Schellongowski, P, Muller, A, Lemiale, V, Mokart, D and Azoulay, E
Publicada:
1 jul 2019
Ahead of Print:
29 may 2019
Categoría:
Critical care and intensive care medicine
Resumen:
PurposeThe number of averted deaths due to therapeutic advances in oncology and hematology is substantial and increasing. Survival of critically ill cancer patients has also improved during the last 2decades. However, these data stem predominantly from unadjusted analyses. The aim of this study was to assess the impact of ICU admission year on short-term survival of critically ill cancer patients, with special attention on those with neutropenia.MethodsSystematic review and meta-analysis of individual data according to the guidelines of meta-analysis of observational studies in epidemiology.DatasourcePubmed and Cochrane databases.Eligibility criteriaAdult studies published in English between May 2005 and May 2015.ResultsOverall, 7354 patients were included among whom 1666 presented with neutropenia at ICU admission. Median ICU admission year was 2007 (IQR 2004-2010; range 1994-2012) and median number of admissions per year was 693 (IQR 450-1007). Overall mortality was 47.7%. ICU admission year was associated with a progressive decrease in hospital mortality (OR per year 0.94; 95% CI 0.93-0.95). After adjustment for confounders, year of ICU admission was independently associated with hospital mortality (OR for hospital mortality per year: 0.96; 95% CI 0.95-0.97). The association was also seen in patients with neutropenia but not in allogeneic stem cell transplant recipients.ConclusionAfter adjustment for patient characteristics, severity of illness and clustering, hospital mortality decreased steadily over time in critically ill oncology and hematology patients except for allogeneic stem cell transplant recipients.
Filiaciones:
Darmon, M:
St Louis Univ Hosp, AP HP, Med ICU, Paris, France
Univ Paris Diderot, Sorbonne Paris Cite, Fac Med, Paris, France
INSERM, ECSTRA Team, Biostat & Clin Epidemiol,Sorbonne Paris Cite, UMR 1153,Ctr Epidemiol & Biostat,CRESS, Paris, France
Bourmaud, A:
Univ Paris Diderot, Sorbonne Paris Cite, Fac Med, Paris, France
Robert Debre Univ Hosp, AP HP, Dept Publ Hlth, Paris, France
Paris Diderot Univ, UMRS 1123, Clin Epidemiol & Econ Evaluat Appl Vulnerable Pop, Paris, France
Georges, Q:
St Etienne Univ Hosp, Med Surg ICU, St Etienne, France
Soares, M:
DOr Inst Res & Educ, Dept Crit Care, Rio De Janeiro, Brazil
DOr Inst Res & Educ, Grad Program Translat Med, Rio De Janeiro, Brazil
Jeon, K:
Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Crit Care Med, Seoul, South Korea
Oeyen, S:
Ghent Univ Hosp, Dept Intens Care Med, Ghent, Belgium
Rhee, CK:
Catholic Univ Korea, Dept Internal Med, Div Pulm & Crit Care Med, Seoul, South Korea
Gruber, P:
Royal Marsden Hosp, Dept Crit Care, Fulham Rd, London SW3 6JJ, England
Ostermann, M:
Kings Coll London, Guys & St Thomas NHS Fdn Hosp, Dept Crit Care & Nephrol, London, England
Hill, QA:
Leeds Teaching Hosp, Dept Haematol, Leeds, W Yorkshire, England
Depuydt, P:
Ghent Univ Hosp, Dept Intens Care Med, Ghent, Belgium
:
Univ Autonoma Barcelona, Dept Clin Hematol, ICO Hosp Germans Trias & Pujol, Josep Carreras Res Inst, Badalona, Spain
Toffart, AC:
Grenoble Alpes Univ Hosp, Thorac Oncol Unit, Grenoble, France
Schellongowski, P:
Med Univ Vienna, Ctr Comprehens Canc, Intens Care Unit 13i2, Dept Med 1, Vienna, Austria
Muller, A:
Univ Fed Rio Grande do Sul, Porto Alegre, RS, Brazil
Lemiale, V:
St Louis Univ Hosp, AP HP, Med ICU, Paris, France
Mokart, D:
Inst Paoli Calmette, Anesthesiol & Intens Care Unit, Marseille, France
Azoulay, E:
St Louis Univ Hosp, AP HP, Med ICU, Paris, France
Univ Paris Diderot, Sorbonne Paris Cite, Fac Med, Paris, France
INSERM, ECSTRA Team, Biostat & Clin Epidemiol,Sorbonne Paris Cite, UMR 1153,Ctr Epidemiol & Biostat,CRESS, Paris, France
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