General Prognostic Scores in Outcome Prediction for Cancer Patients Admitted to the Intensive Care Unit

Kopterides, Petros; Liberopoulos, Panayiotis; Ilias, Ioannis; Anthi, Anastasia; Pragkastis, Dimitrios; Tsangaris, Iraklis; Tsaknis, Georgios; Armaganidis, Apostolos; Dimopoulou, Ioanna

doi:10.4037/ajcc2011763

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Critical Care Evaluation| January 01 2011

General Prognostic Scores in Outcome Prediction for Cancer Patients Admitted to the Intensive Care Unit

Petros Kopterides, MD;

Petros Kopterides, MD

Petros Kopterides, Iraklis Tsangaris, Georgios Tsaknis, Apostolos Armaganidis, and Ioanna Dimopoulou are in the 2nd critical care department, and Panayiotis Liberopoulos is in the pulmonary medicine department at “Attiko” University Hospital, Athens, Greece. Ioannis Ilias is in the endocrinology department at “Elena Venizelou” Hospital, Athens, Greece, Anastasia Anthi is in the 2nd critical care department at “Attiko” University Hospital, and she and Dimitrios Pragkastis are in the critical care department at “Metaxa” Hospital, Pireas, Greece

Corresponding author: Petros Kopterides, md, 2nd Critical Care Dept, “Attiko” University Hospital, 1 Rimini Str, Haidari, Athens 12462, Greece (e-mail: [email protected]).

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Panayiotis Liberopoulos, MD;

Panayiotis Liberopoulos, MD

Petros Kopterides, Iraklis Tsangaris, Georgios Tsaknis, Apostolos Armaganidis, and Ioanna Dimopoulou are in the 2nd critical care department, and Panayiotis Liberopoulos is in the pulmonary medicine department at “Attiko” University Hospital, Athens, Greece. Ioannis Ilias is in the endocrinology department at “Elena Venizelou” Hospital, Athens, Greece, Anastasia Anthi is in the 2nd critical care department at “Attiko” University Hospital, and she and Dimitrios Pragkastis are in the critical care department at “Metaxa” Hospital, Pireas, Greece

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Ioannis Ilias, MD;

Ioannis Ilias, MD

Petros Kopterides, Iraklis Tsangaris, Georgios Tsaknis, Apostolos Armaganidis, and Ioanna Dimopoulou are in the 2nd critical care department, and Panayiotis Liberopoulos is in the pulmonary medicine department at “Attiko” University Hospital, Athens, Greece. Ioannis Ilias is in the endocrinology department at “Elena Venizelou” Hospital, Athens, Greece, Anastasia Anthi is in the 2nd critical care department at “Attiko” University Hospital, and she and Dimitrios Pragkastis are in the critical care department at “Metaxa” Hospital, Pireas, Greece

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Anastasia Anthi, MD;

Anastasia Anthi, MD

Petros Kopterides, Iraklis Tsangaris, Georgios Tsaknis, Apostolos Armaganidis, and Ioanna Dimopoulou are in the 2nd critical care department, and Panayiotis Liberopoulos is in the pulmonary medicine department at “Attiko” University Hospital, Athens, Greece. Ioannis Ilias is in the endocrinology department at “Elena Venizelou” Hospital, Athens, Greece, Anastasia Anthi is in the 2nd critical care department at “Attiko” University Hospital, and she and Dimitrios Pragkastis are in the critical care department at “Metaxa” Hospital, Pireas, Greece

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Dimitrios Pragkastis, MD;

Dimitrios Pragkastis, MD

Petros Kopterides, Iraklis Tsangaris, Georgios Tsaknis, Apostolos Armaganidis, and Ioanna Dimopoulou are in the 2nd critical care department, and Panayiotis Liberopoulos is in the pulmonary medicine department at “Attiko” University Hospital, Athens, Greece. Ioannis Ilias is in the endocrinology department at “Elena Venizelou” Hospital, Athens, Greece, Anastasia Anthi is in the 2nd critical care department at “Attiko” University Hospital, and she and Dimitrios Pragkastis are in the critical care department at “Metaxa” Hospital, Pireas, Greece

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Iraklis Tsangaris, MD;

Iraklis Tsangaris, MD

Petros Kopterides, Iraklis Tsangaris, Georgios Tsaknis, Apostolos Armaganidis, and Ioanna Dimopoulou are in the 2nd critical care department, and Panayiotis Liberopoulos is in the pulmonary medicine department at “Attiko” University Hospital, Athens, Greece. Ioannis Ilias is in the endocrinology department at “Elena Venizelou” Hospital, Athens, Greece, Anastasia Anthi is in the 2nd critical care department at “Attiko” University Hospital, and she and Dimitrios Pragkastis are in the critical care department at “Metaxa” Hospital, Pireas, Greece

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Georgios Tsaknis, MD;

Georgios Tsaknis, MD

Petros Kopterides, Iraklis Tsangaris, Georgios Tsaknis, Apostolos Armaganidis, and Ioanna Dimopoulou are in the 2nd critical care department, and Panayiotis Liberopoulos is in the pulmonary medicine department at “Attiko” University Hospital, Athens, Greece. Ioannis Ilias is in the endocrinology department at “Elena Venizelou” Hospital, Athens, Greece, Anastasia Anthi is in the 2nd critical care department at “Attiko” University Hospital, and she and Dimitrios Pragkastis are in the critical care department at “Metaxa” Hospital, Pireas, Greece

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Apostolos Armaganidis, MD;

Apostolos Armaganidis, MD

Petros Kopterides, Iraklis Tsangaris, Georgios Tsaknis, Apostolos Armaganidis, and Ioanna Dimopoulou are in the 2nd critical care department, and Panayiotis Liberopoulos is in the pulmonary medicine department at “Attiko” University Hospital, Athens, Greece. Ioannis Ilias is in the endocrinology department at “Elena Venizelou” Hospital, Athens, Greece, Anastasia Anthi is in the 2nd critical care department at “Attiko” University Hospital, and she and Dimitrios Pragkastis are in the critical care department at “Metaxa” Hospital, Pireas, Greece

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Ioanna Dimopoulou, MD

Petros Kopterides, Iraklis Tsangaris, Georgios Tsaknis, Apostolos Armaganidis, and Ioanna Dimopoulou are in the 2nd critical care department, and Panayiotis Liberopoulos is in the pulmonary medicine department at “Attiko” University Hospital, Athens, Greece. Ioannis Ilias is in the endocrinology department at “Elena Venizelou” Hospital, Athens, Greece, Anastasia Anthi is in the 2nd critical care department at “Attiko” University Hospital, and she and Dimitrios Pragkastis are in the critical care department at “Metaxa” Hospital, Pireas, Greece

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Am J Crit Care (2011) 20 (1): 56–66.

https://doi.org/10.4037/ajcc2011763

Background

Intensivists and nursing staff are often reluctant to admit patients with cancer to the intensive care unit even though these patients’ survival rate has improved since the 1980s.

Objective

To identify factors associated with mortality in cancer patients admitted to the intensive care unit and to assess and compare the effectiveness of 3 general prognostic models: the Acute Physiology and Chronic Health Evaluation (APACHE) II, the Simplified Acute Physiology Score (SAPS II), and the Sequential Organ Failure Assessment (SOFA).

Methods

A prospective observational cohort study was performed in 2 general intensive care units. Discrimination was assessed by using area under the receiver operating characteristic curves, and calibration was evaluated by using Hosmer-Lemeshow goodness-of-fit tests.

Results

A total of 126 patients were included during a 3-year period. The observed mortality was 46.8%. All 3 general models showed excellent discrimination (area under the curve >0.8) and good calibration (P = .17, .14, and .22 for APACHE II, SAPS II, and SOFA, respectively). However, discrimination was significantly better with APACHE II scores than with SOFA scores (P = .02). Multivariate analyses indicated that independent of the 3 severity-of-illness scores, unfavorable risk factors for mortality included a patient’s preadmission performance status, source of admission (internal medicine vs surgery department), and the presence of septic shock, infection, or anemia. Combining SOFA and SAPS II scores with these variables created prognostic models with improved calibration and discrimination.

Conclusions

The general prognostic models seem fairly accurate in the prediction of mortality in critically ill cancer patients in the intensive care unit.

2011

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