Letter to the Editor
Oncological patients admitted to an intensive care unit: Analysis and evolution
Análisis de factores predictivos de mortalidad y evolución del paciente oncológico ingresado en cuidados intensivos
a Unidad de Medicina Intensiva, Complejo Hospitalario de Soria, Soria, Spain
b Escuela Universitaria de Fisioterapia de Soria, Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Unidad de Medicina Interna, Complejo Hospitalario de Soria, Soria, Spain
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Usefulness of three severity score systems</span>”.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prognostic scales and their application to the cancer patient have not yet shown specific results, nor the specificity necessary for these patients.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The original prognostic scoring systems in the ICUs were implemented in the 1980s. They included an acute physiology and chronic health evaluation (APACHE-I, II, III), a short version of simplified acute physiology (SAPS-II), and later versions, such as the intensive care mortality model (ICMM). In cancer patients this has been identified as inadequate for predicting individual outcomes. A systematic review of prognostic models studied in these patients found that the general prognostic models were adequate for identifying very ill patients, but tended to underestimate the risk of mortality in cancer patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Due to the low sensitivity and specificity of these instruments in cancer patients, recent research has tried to incorporate the prognostic implications of organ dysfunction in predictive models, such as the LOD, SOFA and MODS scales. The scores obtained with these scales were compared with previous models in an attempt to improve discrimination to predict specific outcomes.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The organ dysfunction calculation from these models has been successful in categorising extreme cases of disease, but it remains nonspecific in predicting patient outcomes. However, they do provide meaningful data for clinicians to use along with their expertise to advise patients and families about the severity of their illness and the possible outcomes. Several studies have used these scales daily rather than for the first 24<span class="elsevierStyleHsp" style=""></span>h only, allowing tendencies to be identified, which is very important in cancer patients.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We have carried out a study similar to the one cited in your article. It consists of a retrospective observational study which included patients admitted to the ICU of a secondary hospital between January 2013 and December 2017. It included patients admitted to the ICU with a diagnosis of tumour (solid or hematological). The comparison was made with a control group of patients admitted to the ICU with no oncological history, chosen by severity upon admission according to the <span class="elsevierStyleItalic">propensity score.</span> The complete study included 490 patients, of which 245 had a history of cancer.</p><p id="par0030" class="elsevierStylePara elsevierViewall">During the study period, 245 patients diagnosed with cancer were admitted to the ICU. The mean age of the patients was 71.71 years. 64.9% of the patients were male. There were no significant differences regarding the previous comorbidities presented in both groups, analysed using the Charlson index. Neither were there significant differences in the APACHE-II score upon admission (18.28 vs 19.76; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.643). The most common type of tumour was the solid tumour, present in up to 81% of patients, compared to only 19% of cases with hematological tumours. The most frequent solid tumours were those of the gastrointestinal system (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>83; 33.9%), followed by the genitourinary system (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>41; 16.7%), while the most frequent hematological tumours were lymphomas. The place of origin was the surgical unit in 40.8%. A total of 38 cancer patients (15.5%) died during their stay in the ICU, 28 of them in the first 72<span class="elsevierStyleHsp" style=""></span>h (18 due to limitation of therapeutic effort). When compared to non-cancer patients, there was no significant difference in relation to mortality: 37 patients (15.1%) died.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The mean APACHE-II values upon admission, as we have mentioned, did not show statistically significant differences, although the logistic regression analysis showed an independent association with the mortality in both groups: APACHE-II cancer (OR: 1.032; CI 95%: 1.01–1.17) and APACHE-II non-cancer (OR: 1.16; CI 95%: 1.07–1.25). The AUROC calculated for APACHE-II in cancer patients was 0.765 (CI 95%: 0.67–0.89), and in non-cancer patients it was 0.760 (CI 95%: 0.64−0.9), showing large differentiation if we analyse both groups separately, but finding the opposite when comparing both groups.</p><p id="par0040" class="elsevierStylePara elsevierViewall">More prospective multicentre studies are needed to find the ideal predictor for this population.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Márquez Romera C, del Villar Sordo V. Análisis de factores predictivos de mortalidad y evolución del paciente oncológico ingresado en cuidados intensivos. Med Clin (Barc). 2021;156:200–201.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and outcome of patients with solid tumour requiring admission to the intensive care unit. Usefulness of three severity score systems" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.L. Pérez Pérez" 1 => "A. Gonzaga López" 2 => "B. Balandín Moreno" 3 => "C. Maximiano Alonso" 4 => "Palacios Castañeda" 5 => "J. 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