Quality of life aspects in oncologic patients who survived an intensive care unit admission

Introduction

The number of organ failures in oncologic patients admitted to the ICU is a good predictor of mortality. We propose to analyze the association of this variable and quality of life (QOL) aspects in oncologic patients who survived an ICU admission.

Methods

ICU data were prospectively collected from March 2003 to November 2005. Oncologic patients were selected. QOL aspects were evaluated through the analysis of independence to accomplish daily living activities (IADL) after ICU discharge, defined as the patient's ability to walk, eat by mouth, maintain an oriented conversation and bath himself. The number of organ failures was assessed through the SOFA score. Severe organ dysfunction (SOD) was defined if the patient had three or four points in any of the six domains of the SOFA score. According to the number of SOD, patients were divided into two groups: one with two or less SODs and another with three or more SODs. Groups were compared using Fisher's exact test.

Results

Seventy out of 793 patients had an oncologic diagnosis. The mean age was 52 ± 19 years, male gender 56%, medical admission 77%, hematological malignancies 47% and mean APACHE II score 20 ± 8. ICU mortality was 53% and inhospital mortality was 71%. Nine (13%) patients were discharged of the hospital with complete IADL. Mortality in the group admitted with three or more SODs was 100%, while in the other group it was 39% (P = 0.01, OR 2.5 95% CI 1.8–3.6). During the ICU stay, patients who developed three or more SODs had a higher ICU and inhospital mortality than the ones who did not (89 × 23%, P < 0.001, OR 7, 95% CI 1.8–26 and 100 × 53%, P < 0.001, OR 2, 95% CI 1.4–2.6) and a smaller proportion of IADL after ICU and hospital discharge (0 × 22%, P = 0.04, OR 1.7, 95% CI 1.3–2.2 and 0 × 47%, P < 0.001, OR 2, 95% CI 1.4–2.6).

Conclusion

Mortality should not be the only aspect analyzed when considering an ICU admission for an oncologic patient. The QOL, including IADL, must be taken into account. A higher number of SODs during the entire ICU stay is associated with higher ICU and inhospital mortality. Beyond this association, a smaller number of SODs may be associated with higher probability of IADL.