This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Soares, M. Articles by Spector, N. Search for Related Content PubMed PubMed Citation Articles by Soares, M. Articles by Spector, N. Social Bookmarking                            What's this?

Prognosis of Critically Ill Patients With Cancer and Acute Renal Dysfunction

Márcio Soares, Jorge I.F. Salluh, Marilia S. Carvalho, Michael Darmon, José R. Rocco, Nelson Spector

From the Intensive Care Unit, Instituto Nacional de Câncer; Intensive Care Unit, Hospital Barra D'Or; Departamento de Epidemiologia e Métodos Quantitativos, Escola Nacional de Saúde Publica, Fundação Oswaldo Cruz; Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro; Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Medical Intensive Care Unit, Saint Louis University Hospital and Paris 7 University; and Assistance Publique - Hôpitaux de Paris, Paris, France

Address reprint requests to Márcio Soares, MD, PhD, Instituto Nacional de Câncer –INCA, Centro de Tratamento Intensivo –10° Andar, Pça. Cruz Vermelha, 23, Rio de Janeiro –RJ –Brazil, CEP: 20230-130; e-mail: marciosoaresms{at}yahoo.com.br or marciosoaresms{at}globo.com

PURPOSE: To evaluate the outcomes of critically ill patients with cancer and acute renal dysfunction.

PATIENTS AND METHODS: Prospective cohort study conducted at a 10-bed oncologic medical-surgical intensive care unit (ICU) over a 56-month period.

RESULTS: Of 975 patients, 309 (32%) had renal dysfunction and were studied. Their mean age was 60.9 ± 15.9 years; 233 patients (75%) had solid tumors and 76 (25%) had hematologic malignancies. During the ICU stay, 98 patients (32%) received dialysis. Renal dysfunction was multifactorial in 56% of the patients, and the main associated factors were shock/ischemia (72%) and sepsis (63%). Overall hospital and 6-month mortality rates were 64% and 73%, respectively. Among patients who required dialysis, mortality rates were lower in patients who received dialysis on the first day of ICU in comparison with those who required it thereafter. In a multivariable Cox model, age more than 60 years, uncontrolled cancer, impaired performance status, and more than two associated organ failures were associated with increased 6-month mortality. Renal function was completely re-established in 82% and partially re-established in 12%, and only 6% of survivors required chronic dialysis.

CONCLUSION: Acute renal dysfunction is frequent in critically ill patients with cancer. Although mortality rates are high, selected patients can benefit from ICU care and advanced organ support. When evaluating prognosis and the appropriateness of dialysis in these patients, older age, functional capacity, cancer status and the severity of associated organ failures are important variables to take into consideration.

Supported by institutional funds.

Presented in part at the 18th Annual Meeting of The European Society of Intensive Care Medicine, Amsterdam, the Netherlands, September 25-29, 2005.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J. Nieto, M. L. Grossbard, and P. Kozuch Metastatic Pancreatic Cancer 2008: Is the Glass Less Empty? Oncologist, May 1, 2008; 13(5): 562 - 576. [Abstract] [Full Text] [PDF]