Outcome of Critically Ill Patients with Testicular Cancer.

PURPOSE: To evaluate the clinical characteristics and outcomes of critically ill patients with testicular cancer (TC) admitted to an oncological intensive care unit (ICU). METHODS: This was a prospective observational study. There were no interventions. RESULTS: During the study period, 1,402 patients with TC were admitted to the Department of Oncology, and 60 patients (4.3%) were admitted to the ICU. The most common histologic type was nonseminomatous germ cell tumors (55/91.7%). The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The Cox multivariate analysis identified the white blood cells count (HR = 1.06, 95% CI = 1.01-1.11, and P = 0.005), ionized calcium (iCa) level (HR = 1.23, 95% CI = 1.01-1.50, and P = 0.037), and 2 or more organ failures during the first 24 hours after ICU admission (HR = 3.86, 95% CI = 1.96-7.59, and P < 0.001) as independent predictors of death for up to 6 months. CONCLUSION: The ICU, hospital, and 6-month mortality rates were 38.3%, 45%, and 63.3%, respectively. The factors associated with an increased 6-month mortality rate were white blood cells count, iCa level, and 2 or more organ failures during the first 24 hours after ICU admission.

Outcomes of critically ill cancer patients with Acinetobacter baumannii infection.

AIM: To describe the intensive care unit (ICU) outcomes of critically ill cancer patients with Acinetobacter baumannii (AB) infection. METHODS: This was an observational study that included 23 consecutive cancer patients who acquired AB infections during their stay at ICU of the National Cancer Institute of Mexico (INCan), located in Mexico City. Data collection took place between January 2011, and December 2012. Patients who had AB infections before ICU admission, and infections that occurred during the first 2 d of ICU stay were excluded. Data were obtained by reviewing the electronic health record of each patient. This investigation was approved by the Scientific and Ethics Committees at INCan. Because of its observational nature, informed consent of the patients was not required. RESULTS: Throughout the study period, a total of 494 critically ill patients with cancer were admitted to the ICU of the INCan, 23 (4.6%) of whom developed AB infections. Sixteen (60.9%) of these patients had hematologic malignancies. Most frequent reasons for ICU admission were severe sepsis or septic shock (56.2%) and postoperative care (21.7%). The respiratory tract was the most frequent site of AB infection (91.3%). The most common organ dysfunction observed in our group of patients were the respiratory (100%), cardiovascular (100%), hepatic (73.9%) and renal dysfunction (65.2%). The ICU mortality of patients with 3 or less organ system dysfunctions was 11.7% (2/17) compared with 66.6% (4/6) for the group of patients with 4 or more organ system dysfunctions (P = 0.021). Multivariate analysis identified blood lactate levels (BLL) as the only variable independently associated with in-ICU death (OR = 2.59, 95%CI: 1.04-6.43, P = 0.040). ICU and hospital mortality rates were 26.1% and 43.5%, respectively. CONCLUSION: The mortality rate in critically ill patients with both HM, and AB infections who are admitted to the ICU is high. The variable most associated with increased mortality was a BLL ≥ 2.6 mmol/L in the first day of stay in the ICU.

Organ dysfunction in critically ill cancer patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.

The aim of the present study was to observe the incidence of organ dysfunction and the intensive care unit (ICU) outcomes of critically ill cancer patients during the cytoreductive surgery with hyperthermic intraperitoneal chemotherapy post-operative period. The present study included 25 critically ill cancer patients admitted to the ICU of the National Cancer Institute (Mexico City, Mexico) between January 2007 and February 2013. The incidence of organ dysfunction was 68% and patients exhibiting ≤1 organ system dysfunction during ICU admittance remained in hospital for a significantly shorter period compared with patients who exhibited ≥2 organ system dysfunctions (12.4±10.7 vs. 24.1±12.8 days; P=0.025). Therefore, the present study demonstrated that a high incidence of organ dysfunction was associated with a longer ICU hospital stay.

Hypomagnesaemia in critically ill patients with haematological malignancies.

INTRODUCTION: There is currently little information regarding the incidence of hypomagnesaemia and its impact on the prognosis of critically ill patients with haematological malignancies. OBJECTIVE: This study sought to describe the incidence of hypomagnesaemia in critically ill patients with haematological malignancies admitted to an oncological intensive care unit (ICU). METHODS: A total of 102 critically ill patients with haematological malignancies, who were 18 years of age and admitted to the ICU between January 2008 and April 2011, were included in this study. Hypomagnesaemia was defined as a serum magnesium concentration below 1.7 mg/dl. RESULTS: The incidence of hypomagnesaemia at admission or during the first 24 hours of stay in the ICU was 22.5% (23/102). The hospital mortality rates of patients with and without hypomagnesaemia were 47.8% and 60.7%, respectively. CONCLUSION: The incidence of hypomagnesaemia in critically ill patients with haematological malignancies was 22.5%. Mortality in the ICU and in the hospital was similar in patients with and without hypomagnesaemia.

INTRODUCCIÓN: En la actualidad existe poca información relacionada con la incidencia de hipomagnesemia y su impacto en el pronóstico de pacientes hematológicos críticamente enfermos. OBJETIVO: Describir la incidencia de hipomagnesemia en pacientes hematológicos ingresados a en una unidad de cuidados intensivos (UCI) oncológica. MÉTODOS: Se incluyeron 102 pacientes con enfermedad hematológica, mayores de 18 años, ingresados en la UCI entre enero 2008 y abril 2011. Se definió hipomagnesemia como concentración sérica de magnesio inferior a 1,7 mg/dl. RESULTADOS: La incidencia de hipomagnesemia al ingreso o durante las primeras 24 horas de estancia en la UCI fue del 22,5% (23/102). La mortalidad hospitalaria de los enfermos con y sin hipomagnesemia fue del 47,8% y 60,7%, respectivamente. CONCLUSIÓN: La incidencia de hipomagnesemia en pacientes hematológicos críticamente enfermos fue del 22,5%. La mortalidad en UCI y en el hospital fue similar en los enfermos con y sin hipomagnesemia.

Hipomagnesemia en pacientes hematológicos críticamente enfermos / Hypomagnesaemia in critically ill patients with haematological malignancies

Introducción: En la actualidad existe poca información relacionada con la incidencia de hipomagnesemia y su impacto en el pronóstico de pacientes hematológicos críticamente enfermos. Objetivo: Describir la incidencia de hipomagnesemia en pacientes hematológicos ingresados a en una unidad de cuidados intensivos (UCI) oncológica. Métodos: Se incluyeron 102 pacientes con enfermedad hematológica, mayores de 18 años, ingresados en la UCI entre enero 2008 y abril 2011. Se definió hipomagnesemia como concentración sérica de magnesio inferior a 1,7 mg/dl. Resultados: La incidencia de hipomagnesemia al ingreso o durante las primeras 24 horas de estancia en la UCI fue del 22,5% (23/102). La mortalidad hospitalaria de los enfermos con y sin hipomagnesemia fue del 47,8% y 60,7%, respectivamente. Conclusión: La incidencia de hipomagnesemia en pacientes hematológicos críticamente enfermos fue del 22,5%. La mortalidad en UCI y en el hospital fue similar en los enfermos con y sin hipomagnesemia (AU)

Introduction: There is currently little information regarding the incidence of hypomagnesaemia and its impact on the prognosis of critically ill patients with haematological malignancies. Objective: This study sought to describe the incidence of hypomagnesaemia in critically ill patients with haematological malignancies admitted to an oncological intensive care unit (ICU). Methods: A total of 102 critically ill patients with haematological malignancies, who were 18 years of age and admitted to the ICU between January 2008 and April 2011, were included in this study. Hypomagnesaemia was defined as a serum magnesium concentration below 1.7 mg/dl. Results: The incidence of hypomagnesaemia at admission or during the first 24 hours of stay in the ICU was 22.5% (23/102). The hospital mortality rates of patients with and without hypomagnesaemia were 47.8% and 60.7%, respectively. Conclusion: The incidence of hypomagnesaemia in critically ill patients with haematological malignancies was 22.5%. Mortality in the ICU and in the hospital was similar in patients with and without hypomagnesaemia (AU)

Urgencias metabólicas en pacientes críticos con cáncer / Metabolic emergencies in critically ill cancer patients

Las alteraciones metabólicas graves que ocurren con frecuencia en pacientes oncológicos críticamente enfermos incluyen: hipercalcemia, hipocalcemia, hiponatremia, síndrome de lisis tumoral, alteraciones metabólicas asociadas a insuficiencia renal y acidosis láctica. Los enfermos oncológicos con urgencias metabólicas deben ser tratados en un departamento de oncología médica o en una unidad de cuidados intensivos. La mayor parte de las urgencias metabólicas se pueden tratar de forma adecuada cuando son identificadas de forma temprana. El clínico debe considerar, que el pronóstico de los pacientes oncológicos críticamente enfermos depende de su enfermedad primaria, las comorbilidades y las fallas orgánicas (AU)

Severe metabolic alterations frequently occur in critically ill cancer patients; hypercalcemia, hypocalcemia, hyponatremia, tumor lysis syndrome, metabolic complications of renal failure and lactic acidosis. Cancer patients with metabolic emergencies should be treated in a medical oncology department or an intensive care unit. Most metabolic emergencies can be treated properly when they are identified early. The clinician should consider that the prognosis of critically ill cancer patients depends on their primary disease, comorbidities and organ failure (AU)

[Metabolic emergencies in critically ill cancer patients]. / Urgencias metabolicas en pacientes criticos con cancer.

Severe metabolic alterations frequently occur in critically ill cancer patients; hypercalcemia, hypocalcemia, hyponatremia, tumor lysis syndrome, metabolic complications of renal failure and lactic acidosis. Cancer patients with metabolic emergencies should be treated in a medical oncology department or an intensive care unit. Most metabolic emergencies can be treated properly when they are identified early. The clinician should consider that the prognosis of critically ill cancer patients depends on their primary disease, comorbidities and organ failure.

Las alteraciones metabólicas graves que ocurren con frecuencia en pacientes oncológicos críticamente enfermos incluyen: hipercalcemia, hipocalcemia, hiponatremia, síndrome de lisis tumoral, alteraciones metabólicas asociadas a insuficiencia renal y acidosis láctica. Los enfermos oncológicos con urgencias metabólicas deben ser tratados en un departamento de oncología médica o en una unidad de cuidados intensivos. La mayor parte de las urgencias metabólicas se pueden tratar de forma adecuada cuando son identificadas de forma temprana. El clínico debe considerar, que el pronóstico de los pacientes oncológicos críticamente enfermos depende de su enfermedad primaria, las comorbilidades y las fallas orgánicas.