|Hani M S Lababidi, Abrar Alajlani, Abdullah Alasmari, Wajed Alshammeri, Wejdan Khalid Suwayyid, Ahmed A Bahnassy
Background: Many cancer patients need admission to intensive care unit (ICU). It is important to identify patients who will benefit most from ICU care. Objective: The current study aimed to identify the clinical features associated with outcomes and factors predicting ICU mortality of cancer patients at a tertiary care hospital in Riyadh, Saudi Arabia. Materials and Methods: This was a single-center, retrospective study of all adult patients with either hematological or solid cancer admitted to ICU between January 2017 and June 2018 at King Fahad Medical City, Riyadh, Saudi Arabia. Collected data included: patients' demographics, type of cancer, diagnosis, stage of disease, number of organs failure, reason for ICU admission, severity scores (Acute Physiology and Chronic Health Evaluation [APACHE] II, and Sepsis-related Organ Failure Assessment [SOFA] score), code status, interventions in the ICU, and outcomes. Results: A total of 108 cancer patients were admitted 128 times to ICU during the specified study period. Overall, mortality rate was 57% with standardized mortality rate according to the APACHE II of 0.75. Associative mortality included: vasopressor agents odds ratio (OR) = 3.44, cardiopulmonary resuscitation (CPR) before ICU admission OR = 3.35, presence of sepsis OR = 2.64, and need for invasive ventilatory support OR = 2.16. A total of 46 patients (43%) had hematological malignancies, whereas 62 (57%) had solid organ malignancies. Septic shock ranked first (44%) as the main reason for ICU admission. The mortality rate among hematological and solid organ cancer patients were 52% and 61%, respectively. The code status was do not resuscitate (DNR) in 55 patients (51%), 22% of the DNR patients were survivors. Twelve patients (22%) were DNR before ICU admission, whereas 43 (78%) were made DNR during their ICU stay. Most of ICU mortalities for both groups occurred within the first 20 days of ICU admission. Conclusion: Cancer patients admitted to ICU has high mortality rates; however, this does not preclude aggressive treatment for some. Factors associated with mortality include vasopressors, CPR, sepsis, and mechanical ventilation. Change of code status to DNR during ICU stay is common.
|Y Vishnu Rohit, Raghu K, M Shabnum
Background: Critical ill will be accessed by sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation. Circulating ischemia-modified albumin is generated under ischemic and oxidative conditions and it reflects the disease severity. Aims and Objectives: The objective of this study is to compare the sensitivity and rapidness of Ischemia Modified Albumin as a biomarker with that of an already established biomarker, C-Reactive Protein in patients identified as critically ill septic patients. Materials and Method: A group of 30 subjects were identified using qSOFA as patients suffering from sepsis and their blood samples were taken. These samples were tested for ischemia modified albumin, an inflammatory biomarker, and each sample was also assessed for CRP. Similarly, control patients were assessed for IMA and CRP as well. Results: The results showed that IMA and CRP were both significantly elevated in sepsis, with mean values of 103.77 ± 15.61 ABSU for IMA and 35.58 ± 19.82 mg/L for CRP. However, it was found that the test performed for serum IMA is a quicker and more cost-effective test than that of CRP. Conclusion: This methodology will lead to the usage of a cheaper and more effective diagnostic and prognostic tool for patients succumbed to sepsis.