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The outcome of cancer patients with acute respiratory distress syndrome.
Pubmed ID: 24331952
Journal: Journal of critical care
Publication Date: Feb. 1, 2014
MeSH Terms: Humans, Adult, Aged, Aged, 80 and over, Adolescent, Age Factors, Middle Aged, Randomized Controlled Trials as Topic, Young Adult, Retrospective Studies, Neoplasms, Critical Illness, APACHE, Respiratory Distress Syndrome
Authors: Smith D, Chen W, Soubani AO, Shehada E
Cite As: Soubani AO, Shehada E, Chen W, Smith D. The outcome of cancer patients with acute respiratory distress syndrome. J Crit Care 2014 Feb;29(1):183.e7-183.e12. Epub 2013 Oct 29.
Studies:
- Acute Respiratory Distress Network (ARDSNet) Studies 01 and 03 Lower versus higher tidal volume, ketoconazole treatment and lisofylline treatment (ARMA/KARMA/LARMA)
- Acute Respiratory Distress Network (ARDSNet) Study 02 Late Steroid Rescue Study (LaSRS)
- Acute Respiratory Distress Network (ARDSNet) Study 04 Assessment of Low tidal Volume and elevated End-expiratory volume to Obviate Lung Injury (ALVEOLI)
- Acute Respiratory Distress Network (ARDSNet) Study 05 Fluid and Catheter Treatment Trial (FACTT)
Abstract
OBJECTIVE: The objective of the study is to determine the 28-day mortality of critically ill cancer patients with acute respiratory distress syndrome (ARDS). DESIGN: This is a retrospective cohort study of patients enrolled in the ARDS Network randomized controlled trials. RESULTS: A total of 2515 patients did not have cancer, and 116 patients had cancer. Patients with cancer were older (median, 61 vs 49 years; P < .0001), more critically ill (the median Acute Physiology and Chronic Health Evaluation III score without cancer comorbidity was 105 for the cancer group compared with 87 for those without cancer; P < 0.0001), and more likely to have pneumonia or sepsis as cause of acute lung injury (79.31% vs 62.70%; P = .0011). The overall mortality at day 28 was 25.7%. Patients with cancer had significantly higher mortality (55.2%) compared with those without cancer (24.3%) (P < .0001). The odds ratio for mortality from ARDS at 28 days for cancer patients was 2.54 (95% confidence interval [CI], 1.570-4.120). Acute Physiology and Chronic Health Evaluation III score and age were found to be significant predictors of outcome in cancer patients with odds ratio of 1.034 (95% CI, 1.007-1.062; P = .0135) and 1.075 (95% CI, 1.024-1.129, P = .0036), respectively. CONCLUSIONS: Cancer patients with ARDS have a significantly higher risk of death compared with those without cancer. The increased risk appeared to be mediated by increased severity of illness at presentation, as well as by age.