Characteristics and outcome of patients with solid tumour requiring admission to the intensive care unit. Usefulness of three severity score systems

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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Area under receiver operating characteristic curves &#40;AUROC&#41; of the three severity scoring systems&#58; SOFA&#44; APACHE II and ICMM&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The intensive care unit &#40;ICU&#41; admission of cancer patients has been controversial during the past three decades due to the poor prognosis&#44; the excessive cost and the assumed futility&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1&#8211;3</span></a> Although ICU-triage criteria based on the literature published two decades ago&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">4&#44;5</span></a> cancer patients are more likely to be non-admitted to the ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The development of diagnostic tools and treatment modalities for the several types of cancer has resulted in lower mortality rates&#44; prolonged survivals and an acceptable quality of life&#46; This fact has led to some physicians towards a broader policy of ICU admission&#44; including those cancer patients requiring mechanical ventilation and some other life-supporting therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#8211;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Most studies about prognosis in critical care have focused on haematology and solid cancer patients and the heterogeneity of this population in term of the nature and curability of their disease has limited the validity of the results&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#8211;12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There are no clear guidelines to determine the appropriate admission of solid tumour patients to ICU and different points of view may exist between physicians who initiate cancer treatment and those who manage the critical care complications&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Severity and organ failure scores could be useful predicting the outcome of cancer patients admitted to the ICU thus helping the medical decision making&#46; Only a few studies have been conducted to address accurately the validity of general and specific severity scores in critically ill solid tumour patients&#44; with inconclusive results for the validation and application in clinical practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">14&#8211;17</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of our study is to analyze the characteristics&#44; outcome&#44; and hospital mortality associated factors of solid cancer patients admitted at a polyvalent ICU in Spain&#46; The general severity scores &#8220;Acute Physiology and Chronic Health Evaluation II&#8221; &#40;APACHE II&#41; and &#8220;Sequential Organ Failure Assessment&#8221; &#40;SOFA&#41;&#44; and the cancer specific severity score &#8220;Intensive Cancer Mortality Model&#8221; &#40;ICMM&#41; were evaluated to estimate the probability of hospital mortality among these patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">This is an observational and retrospective study conducted at a tertiary teaching hospital in Spain with 614 inpatient beds&#44; including 20 polyvalent ICU beds&#46; The study was conducted in accordance with the ethical principles of the Declaration of Helsinki that are consistent about the Good Clinical Practice and the applicable regulatory requirements&#46; The study was approved by the Ethics Committee of our institution&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We included all consecutive adult patients diagnosed of solid cancer prior to the ICU admission during a 7-year period &#40;January 2010&#8211;December 2016&#41;&#46; Patients who stayed in the ICU shorter than 24<span class="elsevierStyleHsp" style=""></span>h&#44; and patients with prolonged remission of malignancy &#40;&#62;5 years&#41; were excluded from the study&#46; In case of multiple admissions to the ICU&#44; only the first was considered&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following information was recorded from patient charts&#58; age&#44; sex&#44; comorbidities&#44; health status assessed with the Eastern Cooperative Oncology Group Performance Status &#40;ECOG PS&#41; scale<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> in the previous three months&#44; as well as variables related with tumour status&#58; site of the primary malignancy&#44; state of the disease &#40;recently diagnosed&#44; stable&#47;remission&#44; or progression&#41; and antineoplastic therapy received before ICU admission&#46; The following variables were recorded at ICU admission&#58; reason for admission&#44; need for life-sustaining interventions such as ventilatory support &#40;non-invasive&#47;invasive mechanical ventilation&#41; for more than 24<span class="elsevierStyleHsp" style=""></span>h&#44; vasopressors&#44; and renal replacement therapy&#46; The severity of the underlying disease and the number of organ failures were calculated on the first day of admission according to the APACHE II<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">19</span></a> and SOFA scores&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">20</span></a> We recorded both ICU and hospital days of stay&#44; and ICU and hospital survival at the time of discharge&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The cancer specific prognosis score ICMM&#44; was calculated according to the original publication by Groege et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> &#40;available on <a href="http://simulacionymedicina.es/icmm/">http&#58;&#47;&#47;simulacionymedicina&#46;es&#47;icmm&#47;</a>&#41;&#46; This score is a disease-specific model that can estimate the percentage of in-hospital mortality in cancer patients at the time of their admission in the ICU&#46; The model integrates 16 variables but we did not include the variable related to allogenic bone marrow transplantation&#46; The result of ICMM score represents the prospect risk of hospital death&#44; ranging from 0&#37; &#40;low probability&#41; to 100&#37; &#40;high probability&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the statistical analysis&#44; categorical data were summarized as absolute frequencies &#40;with their corresponding percentages&#41;&#44; and numerical variables were summarized as medians with the corresponding interquartile range &#40;IQR&#41;&#46; Categorical variables were compared by the <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test or Fischer exact test as appropriate&#44; and continuous variables by Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test or Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#46; Due to the higher mortality usually associated with medical patients compared with surgical patients&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a> the risk factors associated with hospital mortality were adjusted by the reason to ICU admission &#40;medical or scheduled surgery&#41; using a logistic regression analysis&#46; A <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was considered significant&#46; To evaluate the discrimination of the severity scores&#44; the area under the receiver operating characteristic curves &#40;AUROC&#41; were estimated &#40;showed as AUROC with 95&#37; CI&#41;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Calibration was assessed using the Hosmer&#8211;Lemeshow test for goodness-of-fit and we compared the models using a non-parametric DeLong&#39;s test&#46; The Akaike information criterion &#40;AIC&#41; is a measure of the relative quality of statistical models for a given data and a way to select a model from a set of models&#46; The best model was defined with the lower AIC&#46; Stata&#47;IC v&#46; 14&#46;2 software package was used for the statistical analysis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Characteristics of the studied population</span><p id="par0060" class="elsevierStylePara elsevierViewall">During the 7-year period of study&#44; 4847 patients were admitted to the ICU and 132 of them had been diagnosed with a solid tumour at the moment of admission&#46; The main patient characteristics and malignancy-related data are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Most patients were men &#40;61&#46;4&#37;&#41; and the median age was 65 years&#46; A high proportion of patients had comorbidities at the time of admission &#40;81&#46;6&#37;&#41;&#44; being cardiovascular and chronic obstructive pulmonary disease the most frequent&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The most frequent type of tumour was gastrointestinal &#40;37&#46;1&#37;&#41;&#44; followed by lung cancer &#40;24&#46;2&#37;&#41;&#46; The median time from the diagnosis of solid cancer to the ICU admission was 4 months &#40;2&#8211;11&#41;&#46; Almost half of the patients had a recently diagnosed tumour &#40;47&#46;7&#37;&#41;&#44; while 37&#46;9&#37; of patients had a malignancy in progression and 14&#46;4&#37; were stable or in remission&#46; At ICU admission&#44; 49 patients &#40;37&#46;1&#37;&#41; had metastases and 83 &#40;62&#46;9&#37;&#41; had a localized tumour&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Surgery was the most common oncologic therapy previous to admission &#40;59&#46;1&#37;&#41;&#44; followed by chemotherapy &#40;42&#46;4&#37;&#41; and radiotherapy &#40;23&#46;5&#37;&#41;&#46; During the three months before admission to the ICU&#44; 76&#46;5&#37; of patients had an ECOG PS between 0 and 1 and 6&#46;4&#37; had an ECOG PS between 3 and 4&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Fifty-eight &#40;43&#46;9&#37;&#41; of the patients were admitted to the ICU because of a medical reason such as sepsis &#40;18&#46;2&#37;&#41;&#44; respiratory failure &#40;9&#46;9&#37;&#41;&#44; or hypovolemic&#47;cardiogenic shock &#40;8&#46;3&#37;&#41;&#44; while 56&#46;1&#37; of them were admitted after a surgical procedure&#46; Six &#40;4&#46;5&#37;&#41; patients of the series had neutropenia &#40;&#60;500<span class="elsevierStyleHsp" style=""></span>neutrophils&#47;mm<span class="elsevierStyleSup">3</span>&#41; and only one patient of the surgical group had neutropenia at ICU admission&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">During the ICU stay most patients received life-supporting therapies&#44; such as vasopressors &#40;32&#46;6&#37;&#41;&#44; mechanical ventilation &#40;26&#46;5&#37;&#41; or renal replacement therapy &#40;4&#46;5&#37;&#41;&#46; The median value of severity scores APACHE II&#44; SOFA and ICMM was 13 &#40;IQR&#44; 9&#8211;18&#41;&#44; 4 &#40;IQR&#44; 1&#8211;8&#41;&#44; and 30 &#40;IQR&#44; 16&#8211;51&#41;&#44; respectively&#46; Seventeen patients &#40;12&#46;9&#37;&#41; had three or more organ failures&#46; The median duration of ICU and hospital stay was 2 days &#40;IQR&#44; 1&#8211;5&#41; and 12 days &#40;IQR&#44; 8&#8211;25&#41;&#44; respectively&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Outcome and prognostic factors</span><p id="par0090" class="elsevierStylePara elsevierViewall">The ICU and hospital mortality rates were 12&#46;9&#37; &#40;17&#47;132&#41; and 19&#46;7&#37; &#40;26&#47;132&#41;&#44; respectively&#46; The ICU mortality rate during the study period was 12&#46;2&#37;&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the characteristics of patients who died compared with those who survived&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Among the demographic and cancer-associated variables&#44; statistic analysis revealed that gender&#44; age&#44; site of tumour&#44; type of antineoplastic therapy and status of the disease&#44; were not associated with a worse prognosis&#46; Regarding the clinical variables presented at the time of ICU admission&#44; mortality was significantly associated with the number of organ failures and the need of life-supporting therapies&#46; Limitation of therapeutic effort&#44; both in the ICU and in the ward&#44; was performed in 12&#46;8&#37; &#40;17&#47;132&#41; of the patients of the series&#44; but only in 3 patients after scheduled surgery&#46; We have observed a significantly higher mortality in medical patients than in surgical patients &#40;39&#46;6&#37; vs&#46; 4&#46;1&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; However&#44; after adjusting the mortality risk by reason for admission &#40;medical or scheduled surgery&#41; we found that the number of organ failures&#44; the need of life-supporting therapies &#40;mechanical ventilation&#44; vasopressors&#44; or renal replacement therapy&#41; and high severity-scores were still related to a higher mortality rate &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Evaluation of severity scores</span><p id="par0100" class="elsevierStylePara elsevierViewall">The median value of APACHE II&#44; SOFA&#44; and ICMM was significantly higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; in patients who died than in patients who survive&#46; In the logistic regression analysis&#44; the severity scores SOFA &#40;OR 1&#46;3&#44; 95&#37; IC 1&#46;14&#8211;1&#46;48&#41;&#44; APACHE II &#40;OR 1&#46;18&#44; 95&#37; CI 1&#46;09&#8211;1&#46;27&#41;&#44; and ICMM &#40;OR 1&#46;04&#44; 95&#37; CI 1&#46;02&#8211;1&#46;07&#41; were independently associated &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; with a higher mortality &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">AUROC was calculated for APACHE II &#40;0&#46;795&#44; 95&#37; CI 0&#46;69&#8211;0&#46;9&#41;&#44; SOFA &#40;0&#46;77&#44; 95&#37; CI 0&#46;69&#8211;0&#46;864&#41; and ICMM &#40;0&#46;794&#44; 95&#37; CI 0&#46;697&#8211;0&#46;891&#41; showing a good discrimination&#46; The comparison of AUROC of the three severity scores after DeLong&#39;s test showed no difference&#58; SOFA vs APACHE II &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;56&#41;&#44; SOFA vs ICMM &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;41&#41;&#44; and APACHE II vs ICMM &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;78&#41;&#46; In the AIC analysis APACHE II was 108&#46;4&#44; SOFA 112&#46;5&#44; and ICMM 108&#46;5&#46; The one with the lower AIC was the model that represented the prognosis better&#46; APACHE II was the model with the lowest AIC but the difference with the following ones was not significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">This study describes the clinical characteristics and mortality associated factors in a series of solid cancer patients admitted to an ICU in Spain&#46; The data of our cohort offer a broader view of this subset of patients allowing us to characterize the utility of different severity scoring systems in this population&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">It has been widely accepted that cancer patients have a worse prognosis and a higher mortality rate than non-cancer patients&#44; and therefore their admission to the ICU has generally been considered futile&#46; The hospital mortality previously reported in patients with solid tumours after critical illness ranges between 11&#37; and 54&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#8211;12&#44;23&#8211;25</span></a> The ICU mortality and hospital mortality observed in our study has been 12&#46;2&#37; and 19&#46;7&#37;&#44; respectively&#44; a lower threshold comparing with previous reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#8211;12</span></a> We must emphasize that patients with solid tumours are a very heterogeneous population&#44; with different types of cancer and oncologic treatments&#44; as well as specific reason for admission to ICU&#46; Therefore&#44; the mortality rate is different according to the previous studies&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The most frequent reasons leading a patient with a malignancy to ICU are postoperative care&#44; respiratory failure&#44; sepsis and acute kidney injury&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">24&#44;25</span></a> A significant difference in the characteristics and prognosis between medical and scheduled surgical patients has been found&#46; The poor prognosis of cancer patients requiring ICU admission due to a medical reason has been documented&#44; with ICU mortality rates up to 79&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#44;7&#44;9&#8211;12&#44;23&#8211;25</span></a> In the other hand&#44; postsurgical admission of solid tumour patients is reported to be associate with a better outcome&#44; with mortality rates as low as 2&#46;1&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">23&#44;24</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Our study has confirmed the higher mortality rate of medical patients compared with surgical patients &#40;39&#46;6&#37; vs&#46; 4&#46;1&#37;&#41;&#46; However&#44; when the results were adjusted by the reason for ICU admission for different risk factors&#44; the factors associated with a higher mortality remained the same in both groups&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Previous studies have identified several independent risk factors for hospital mortality in solid tumour patients&#44; such as older age&#44; tumour progression&#44; and number and severity of organ failures&#44; especially if life-supporting therapies are required&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">6&#8211;12&#44;23&#8211;25</span></a> Acute respiratory failure requiring mechanical ventilation is one the main reasons for ICU admission and several reports have found that the need of ventilatory support for more than 24<span class="elsevierStyleHsp" style=""></span>h increases the hospital mortality rate up to 100&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">13&#44;24&#44;25</span></a> The need of vasopressors&#44; renal replacement therapy&#44; and other invasive procedures such as blood transfusion&#44; central venous or arterial catheterization&#44; and tracheostomy<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11&#44;23&#44;24&#44;26</span></a> are also factors associated with hospital mortality&#46; These findings support that essentially the number and severity of organ dysfunctions are going to determine the outcome of critically ill patients with solid tumours&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In our series&#44; the age&#44; the primary site of tumour&#44; and cancer progression were not predictive of hospital mortality&#44; suggesting that patient and cancer-related factors have a limited value at ICU admission&#46; This contrasts with other reports in which the characteristics of the patients or the evolution of malignant disease have a strong impact on short-term survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">23&#44;24&#44;26</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">In the critical care setting&#44; scoring systems have been shown to be valuable tools to quantify severity of illness&#44; thus allowing patients at high risk for hospital mortality to be identified&#46; General prognostic models for ICU patients such as APACHE II and SOFA scores tend to underestimate the risk of mortality in critically-ill cancer patients&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a> Prognostic models specifically designed for cancer patients at ICU&#44; as the ICMM&#44; are interesting because they consider specific cancer-related problems&#46; In some reports&#44; the ICMM has shown previously a better calibration and discrimination than general models and being superior predicting mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">16&#44;17</span></a> However&#44; this issue is controversial because some authors refer that there was no advantage using ICMM over the general prognostic models&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">14&#44;15</span></a> Heterogeneity of critically ill cancer patient populations and that specific cancer problems do not seem to be primarily involved in short term survival at ICU admission&#44; may be the main reasons for the lacking superiority of the ICMM compared to standard severity-of-illness scoring systems&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Finally&#44; there has not been a study specifically designed to evaluate ICMM calibration and discrimination in critically ill patients with solid tumours&#46; In our study&#44; we found that SOFA&#44; APACHE II&#44; and ICMM scores were independently associated with higher mortality&#46; Additionally&#44; the three scoring systems had a satisfactorily good discrimination in ICU patients with solid cancer&#46; APACHE II and ICMM performed better than SOFA&#44; being SOFA&#44; the worst score estimating outcome&#46; However&#44; in agreement with previous reports&#44; the ICMM score &#8211; specifically developed to predict prognosis in critically ill cancer patients &#8211; was not superior to APACHE II score and SOFA&#44; since DeLong&#39;s test did not show difference between them&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">We should acknowledge some limitations to this study&#46; First&#44; it is a retrospective study conducted at a single institution and the selection bias could influence the significance of our findings&#46; Second&#44; although the inclusion of postsurgical patients may have modified the results towards a better outcome&#44; using a logistic regression analysis we have minimized the shortcomings&#46; Third&#44; the prognostic scores should be employed in populations with similar characteristics and our group was very heterogeneous&#46; However&#44; to discriminate which of the scores was better we used two statistic methods to trying to be more accurate&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">The similar ICU mortality rate observed in cancer patients&#44; compared to the overall ICU mortality&#44; supports a broader policy to ICU admission in this population&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The medical reason for admission&#44; the number and the severity of organ failures and the need of life-supporting therapies&#44; were variables related to in-hospital mortality&#46; Neither the primary site of the tumour nor the status of the malignant disease was associated with a worse outcome&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">All three models evaluated &#40;APACHE II&#44; SOFA and ICMM&#41; showed a good discrimination predicting hospital mortality of critically ill patients with solid tumours&#44; but none was found to be better than the other to predict the outcome in this population&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Further multicentre and prospective studies are needed to determine the prognostic factors of critical patients with solid tumours and the utility of the severity scoring systems&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0175" class="elsevierStylePara elsevierViewall">All authors declare no conflict of interest or funding for this article&#46;</p></span></span>"
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          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Characteristics of the studied population"
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            1 => array:2 [
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              "titulo" => "Outcome and prognostic factors"
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        7 => array:2 [
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          "titulo" => "Evaluation of severity scores"
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          "identificador" => "sec0045"
          "titulo" => "Conflict of interests"
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        11 => array:2 [
          "identificador" => "xack428791"
          "titulo" => "Acknowledgments"
        ]
        12 => array:1 [
          "titulo" => "References"
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    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-08-15"
    "fechaAceptado" => "2019-01-10"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1160377"
          "palabras" => array:5 [
            0 => "ICU"
            1 => "Solid tumour"
            2 => "Mortality"
            3 => "Severity illness score"
            4 => "Prognosis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1160376"
          "palabras" => array:5 [
            0 => "Unidad de cuidados intensivos"
            1 => "Tumour s&#243;lido"
            2 => "Mortalidad"
            3 => "Escalas de gravedad"
            4 => "Pron&#243;stico"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the characteristics and the evolution of patients with solid tumours admitted to the ICU and to identify factors associated with hospital mortality and to evaluate three illness severity scores&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descriptive study including 132 patients with solid tumour admitted to the ICU &#40;2010&#8211;2016&#41;&#46; Demographics and cancer-related data&#44; organ failures&#44; life-supporting therapies and severity scores&#58; APACHE II&#44; SOFA and ICU Cancer Mortality Model &#40;ICMM&#41; were collected&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There were 58 patients admitted for medical reasons and 74 for scheduled surgery&#46; The ICU and hospital mortality rate were 12&#46;9&#37; and 19&#46;7&#37;&#44; respectively&#46; The medical reason for admission&#44; the number of organ failures&#44; and the need of life-supporting therapies were significantly associated with a higher mortality &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In the logistic regression analysis&#44; the three severity scores&#58; SOFA &#40;OR 1&#46;18&#44; 95&#37; IC 1&#46;14&#8211;1&#46;48&#41;&#44; APACHE II &#40;OR 1&#46;11&#44; 95&#37; CI 1&#46;09&#8211;1&#46;27&#41;&#44; and ICMM &#40;OR 1&#46;03&#44; 95&#37; CI 1&#46;02&#8211;1&#46;07&#41; were independently associated with a higher mortality &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; To evaluate the discrimination&#44; the area under the receiver operating characteristics curves &#40;AUROC&#41; were calculated&#58; APACHE II &#40;0&#46;795&#44; 95&#37; CI 0&#46;69&#8211;0&#46;9&#41;&#44; SOFA &#40;0&#46;77&#44; 95&#37; CI 0&#46;69&#8211;0&#46;864&#41; and ICMM &#40;0&#46;794&#44; 95&#37; CI 0&#46;697&#8211;0&#46;891&#41;&#46; The comparison of AUC ROC after DeLong&#39;s test showed no difference between them&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hospital mortality was associated with the type and severity of acute illness&#46; The three severity scores were useful to assess outcome and accurate in the discrimination&#44; but we did not find a significant difference between them&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas generales y la evoluci&#243;n de los pacientes con tumores s&#243;lidos ingresados en una unidad de cuidados intensivos &#40;UCI&#41;&#44; identificar los factores asociados a la mortalidad y evaluar el valor pron&#243;stico de 3 escalas de gravedad&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo de 132 pacientes con diagn&#243;stico de tumour s&#243;lido admitidos en la UCI &#40;2010-2016&#41;&#46; Se analizaron los datos demogr&#225;ficos relacionados con el tumour&#44; la disfunci&#243;n org&#225;nica y las terapias de soporte vital&#44; as&#237; como las escalas de gravedad APACHE II&#44; SOFA e ICMM&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ingresaron 58 pacientes por causa m&#233;dica y 74 tras cirug&#237;a programada&#46; La tasa de mortalidad en la UCI y hospitalaria fue del 12&#44;9&#37; y 19&#44;7&#37;&#44; respectivamente&#46; La causa m&#233;dica de ingreso&#44; el n&#250;mero de fallos org&#225;nicos y la necesidad de terapias de soporte vital se asociaron significativamente con mayor mortalidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En el an&#225;lisis por regresi&#243;n log&#237;stica las 3 escalas evaluadas&#58; SOFA &#40;OR&#58; 1&#44;18&#59; IC 95&#37;&#58; 1&#44;14-1&#44;48&#41;&#44; APACHE II &#40;OR&#58; 1&#44;11&#59; IC 95&#37;&#58; 1&#44;09-1&#44;27&#41; e ICMM &#40;OR&#58; 1&#44;03&#59; IC 95&#37;&#58; 1&#44;02-1&#44;07&#41; se asociaron de forma independiente con una mayor mortalidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Para evaluar la discriminaci&#243;n&#44; se calcularon las AUROC&#58; APACHE II &#40;0&#44;795&#59; CI 95&#37;&#58; 0&#44;69-0&#44;9&#41;&#44; SOFA &#40;0&#44;77&#59; CI 95&#37;&#58; 0&#44;69-0&#44;864&#41; e ICMM &#40;0&#44;794&#59; CI 95&#37;&#58; 0&#44;697-0&#44;891&#41;&#46; La comparaci&#243;n de las mismas por el test DeLong no mostr&#243; diferencias entre los sistemas de puntuaci&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La mortalidad hospitalaria se asoci&#243; con el tipo y la gravedad de la enfermedad aguda&#46; Las e escalas de gravedad evaluadas fueron igualmente &#250;tiles para evaluar el pron&#243;stico&#44; sin mostrar diferencias entre ellas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
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        "etiqueta" => "Fig&#46; 1"
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        "figura" => array:1 [
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Area under receiver operating characteristic curves &#40;AUROC&#41; of the three severity scoring systems&#58; SOFA&#44; APACHE II and ICMM&#46;</p>"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">APACHE&#44; Acute Physiologic and Chronic Health Evaluation&#59; SOFA&#44; Sequential Organ Failure Assessment&#59; ICMM&#44; Intensive Care Mortality Model&#59; IQR&#44; interquartile range&#46;</p>"
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                  \t\t\t\t">132&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">65 &#40;56&#8211;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Acute ischaemic stroke</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3 &#40;2&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">49 &#40;37&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Lung</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">32 &#40;24&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Genitourinary</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Skin and soft tissues</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10 &#40;7&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other tumors</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Antineoplastic therapy</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Surgery</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;59&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Chemotherapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;42&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Radiotherapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;23&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">State of the disease</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Recently diagnosed</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;47&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Stable&#47;remission</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;14&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Progression</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;37&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Reason for intensive care unit admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Scheduled surgery</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;56&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Medical</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58 &#40;43&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;18&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Acute respiratory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;9&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hypovolemic and cardiogenic shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Number of organ failures</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleItalic">2</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115 &#40;87&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleItalic">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Life-supporting therapies</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mechanical ventilation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;26&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Vasopressors</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Renal replacement therapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Intensive care unit stay</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Hospital stay</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#8211;25&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Severity scores&#44; median &#40;IQR&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">APACHE II</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;9&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">SOFA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;1&#8211;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ICMM</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;16&#8211;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Mortality</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Intensive care unit</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;12&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hospital</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;19&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t">18 &#40;69&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;98 &#40;0&#46;7&#8211;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Recently diagnosed<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">49 &#40;66&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stable&#47;remission&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;16&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;28 &#40;0&#46;5&#8211;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Progression&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">40 &#40;37&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10 &#40;38&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;68 &#40;0&#46;2&#8211;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Diagnosis at ICU admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Scheduled surgery&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">71 &#40;66&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;11&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Medical&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">35 &#40;33&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23 &#40;88&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Number of organ failures</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">99 &#40;93&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;61&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">7 &#40;6&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">10 &#40;38&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">3&#46;54 &#40;1&#46;1&#8211;11&#46;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;03</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Life-supporting therapies</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mechanical ventilation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">15 &#40;14&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;76&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">4&#46;88 &#40;1&#46;7&#8211;13&#46;5&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;02</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vasopressors&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23 &#40;21&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;57&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">4&#46;21 &#40;1&#46;4&#8211;12&#46;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;01</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Renal replacement therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">10&#46;9 &#40;1&#46;2&#8211;97&#46;3&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#46;03</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ICU stay &#40;days&#41;&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2 &#40;1&#8211;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#46;5 &#40;1&#8211;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;00 &#40;0&#46;9&#8211;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Hospital stay &#40;days&#41;&#44; median &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">11&#46;5 &#40;8&#8211;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15&#46;5 &#40;9&#8211;32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;99 &#40;0&#46;9&#8211;1&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                      "titulo" => "Guidelines for intensive care unit admission&#44; discharge&#44; and triage"
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                            0 => "Task Force of the American College of Critical Care Medicine&#44; Society of Critical Care Medicine"
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Characteristics and outcome of patients with solid tumour requiring admission to the intensive care unit. Usefulness of three severity score systems

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Characteristics and outcome of patients with solid tumour requiring admission to the intensive care unit. Usefulness of three severity score systems

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