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dc.creatorFernandez-Ros, N. (Nerea)-
dc.creatorAlegre, F. (Félix)-
dc.creatorRodríguez-Rodríguez, J. (Javier)-
dc.creatorLandecho, M.F. (Manuel F.)-
dc.creatorSunsundegui-Seviné, P. (Patricia)-
dc.creatorGurpide, A. (Alfonso)-
dc.creatorLecumberri, R. (Ramón)-
dc.creatorSanz, E. (Eva)-
dc.creatorGarcia-Gonzalez, N. (Nicolás)-
dc.creatorQuiroga, J. (Jorge)-
dc.creatorLucena-Ramírez, J.F. (Juan Felipe)-
dc.identifier.citationFernández-Ros, N. (Nerea); Alegre-Garrido, F. (Félix); Rodríguez-Rodríguez, J. (Javier); et al. "Long-term outcome of critically III advanced cancer patients managed in an intermediate care unit". Journal of Clinical Medicine. 11 (12), 2022, 3472es
dc.description.abstractBackground: To analyze the long-term outcomes for advanced cancer patients admitted to an intermediate care unit (ImCU), an analysis of a do not resuscitate orders (DNR) subgroup was made. Methods: A retrospective observational study was conducted from 2006 to January 2019 in a single academic medical center of cancer patients with stage IV disease who suffered acute severe complications. The Simplified Acute Physiology Score 3 (SAPS 3) was used as a prognostic and severity score. In-hospital mortality, 30-day mortality and survival after hospital discharge were calculated. Results: Two hundred and forty patients with stage IV cancer who attended at an ImCU were included. In total, 47.5% of the cohort had DNR orders. The two most frequent reasons for admission were sepsis (32.1%) and acute respiratory failure (excluding sepsis) (38.7%). Mortality in the ImCU was 10.8%. The mean predicted in-hospital mortality according to SAPS 3 was 51.9%. The observed in-hospital mortality was 37.5% (standard mortality ratio of 0.72). Patients discharged from hospital had a median survival of 81 (30.75-391.25) days (patients with DNR orders 46 days (19.5-92.25), patients without DNR orders 162 days (39.5-632)). The observed mortality was higher in patients with DNR orders: 52.6% vs. 23.8%, p 0 < 0.001. By multivariate logistic regression, a worse ECOG performance status (3-4 vs. 0-2), a higher SAPS 3 Score and DNR orders were associated with a higher in-hospital mortality. By multivariate analysis, non-invasive mechanical ventilation, higher bilirubin levels and DNR orders were significantly associated with 30-day mortality. Conclusion: For patients with advanced cancer disease, even those with DNR orders, who suffer from acute complications or require continuous monitoring, an ImCU-centered multidisciplinary management shows encouraging results in terms of observed-to-expected mortality ratios.-
dc.subjectAdvanced cancer-
dc.subjectIntermediate care unit-
dc.subjectDo not resuscitate orders-
dc.subjectAcute complications-
dc.titleLong-term outcome of critically III advanced cancer patients managed in an intermediate care unit-
dc.description.noteThis article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license-
dadun.citation.publicationNameJournal of Clinical Medicine-

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