Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency

doi:10.5847/wjem.j.issn.1920-8642.2013.01.008

Abstract

Abstract:

BACKGROUND: This study aimed to investigate the risk factors and outcome of critically ill cancer patients with postoperative acute respiratory insufficiency.
METHODS: The data of 190 critically ill cancer patients with postoperative acute respiratory insufficiency were retrospectively reviewed. The data of 321 patients with no acute respiratory insufficiency as controls were also collected. Clinical variables of the first 24 hours after admission to intensive care unit were collected, including age, sex, comorbid disease, type of surgery, admission type, presence of shock, presence of acute kidney injury, presence of acute lung injury/acute respiratory distress syndrome, acute physiologic and chronic health evaluation (APACHE II) score, sepsis-related organ failure assessment (SOFA), and PaO₂/FiO₂ ratio. Duration of mechanical ventilation, length ofintensive care unit stay, intensive care unit death, length of hospitalization, hospital death and one-year survival were calculated.
RESULTS: The incidence of acute respiratory insufficiency was 37.2% (190/321). Multivariate logistic analysis showed a history of chronic obstructive pulmonary diseases (P=0.001), surgery-related infection (P=0.004), hypo-volemic shock (P<0.001), and emergency surgery (P=0.018), were independent risk factors of postoperative acute respiratory insufficiency. Compared with the patients without acute respiratory insufficiency, the patients with acute respiratory insufficiency had a prolonged length of intensive care unit stay (P<0.001), a prolonged length of hospitalization (P=0.006), increased intensive care unit mortality (P=0.001), and hospital mortality (P<0.001). Septic shock was shown to be the only independent prognostic factor of intensive care unit death for the patients with acute respiratory insufficiency (P=0.029, RR: 8.522, 95%CI: 1.243-58.437, B=2.143, SE=0.982, Wald=4.758). Compared with the patients without acute respiratory insufficiency, those with acute respiratory insufficiency had a shortened one-year survival rate (78.7% vs. 97.1%,P<0.001).
CONCLUSION: A history of chronic obstructive pulmonary diseases, surgery-related infection, hypovolemic shock and emergency surgery were risk factors of critically ill cancer patients with postoperative acute respiratory insufficiency. Septic shock was the only independent prognostic factor of intensive care unit death in patients with acute respiratory insufficiency. Compared with patients without acute respiratory insufficiency, those with acute respiratory insufficiency had adverse short-term outcome and a decreased one-year survival rate.

Key words: Acute respiratory insufficiency, Risk factors, Prognosis, Critical illness, Postoperative care, Septic shock, Chronic obstructive pulmonary disease, Survival

Xue-zhong Xing, Yong Gao, Hai-jun Wang, Quan-hui Yang, Chu-lin Huang, Shi-ning Qu, Hao Zhang, Hao Wang, Qing-ling Xiao, Ke-lin Sun. Risk factors and prognosis of critically ill cancer patients with postoperative acute respiratory insufficiency[J]. World Journal of Emergency Medicine, 2013, 4(1): 43-47.

Figures/Tables 6

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References 15

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Clinical variables	ARI (n=190)	No-ARI (n=321)	t/χ² value	P value
Age (yr)	63.26±12.66	65.64±11.44	1.791	0.074
Sex (male)	124 (65.3)	204 (63.6)	0.152	0.704
Coronary heart disease (%)	26 (13.7)	60 (18.7)	2.138	0.178
Diabetic mellitus (%)	22 (11.6)	37 (11.5)	0.000	0.986
COPD (%)	14 (7.4)	4 (1.2)	13.164	0.001
Procedures performed
Pneumonectomy (%)	11 (5.8)	6 (1.9)	5.704	0.022
Lobectomy (%)	32 (16.8)	5 (15.6)	0.142	0.710
Pulmonary wedge resection (%)	15 (7.9)	24 (7.5)	0.030	0.865
Esophagectomy (%)	50 (26.3)	65 (20.2)	2.519	0.125
Upper abdomen surgery (%)	25 (13.2)	57 (17.8)	1.874	0.212
Lower abdomen surgery (%)	39 (20.5)	79 (24.6)	1.121	0.329
Head and neck surgery (%)	13 (6.8)	40 (12.5)	4.054	0.051
Neurosurgery (%)	6 (3.2)	0 (0)	10.257	0.003
Sepsis
Pulmonary infection (%)	23 (12.1)	0 (0)	40.689	<0.001
Surgery-related infection (%)	27 (14.2)	5 (1.6)	35.522	<0.001
Blood stream infection (%)	3 (1.6)	0 (0)	5.098	0.024
Acute kidney injury (%)	12 (6.3)	4 (1.2)	10.114	0.003
Shock
Hypovolemic shock (%)	30 (15.8)	8 (2.5)	30.659	<0.001
Septic shock (%)	14 (7.4)	0 (0)	24.319	<0.001
Admission			64.228	<0.001
Elective (%)	104 (54.7)	278 (86.6)
Emergent (%)	86 (45.3)	43 (13.4)

Clinical variables	B	S.E.	Wald	RR (95%CI)	P value
COPD	2.004	0.597	11.268	7.416 (2.302-23.890)	0.001
Surgery-related infection	1.597	0.562	8.078	4.939 (1.642-14.857)	0.004
Hypovolemic shock	1.664	0.462	12.990	5.283 (2.137-13.061)	<0.001
Emergent admission	0.654	0.275	5.644	1.923 (1.121-3.297)	0.018

Clinical variables	ARI (n=190)	No-ARI (n=321)	t/χ² value	P value
ICU length of stay (d)	3 (2-6)	2 (1-3)	- 6.493	<0.001
ICU mortality (%)	14 (7.4)	4 (1.2)	13.164	0.001
Length of hospitalization (d)	23 (18-31)	20 (15-25)	- 2.378	0.006
In-hospital mortality (%)	16 (8.4)	5 (1.6)	14.267	<0.001

Clinical variables	Survival (n=176)	Death (n=14)	t/χ²value	P value
Age (yr)	63.52±12.81	65.07±10.99	- 0.441	0.660
Sex (male)	115 (65.3)	9 (64.3)	0.011	0.936
Coronary heart disease (%)	25 (14.2)	1 (7.1)	0.310	0.697
Diabetic mellitus (%)	20 (11.4)	2 (14.3)	0.324	0.668
COPD (%)	13 (7.4)	1 (7.1)	0.017	0.973
Admission			15.490	<0.001
Elective (%)	103 (58.5)	1 (7.1)
Emergency (%)	73 (41.5)	13 (92.9)
Sepsis
Pulmonary infection (%)	19 (10.8)	4 (28.6)	5.425	0.072
Surgery-related infection (%)	23 (13.1)	4 (28.6)	1.223	0.118
Blood stream infection (%)	2 (1.1)	1 (7.1)	3.760	0.206
Acute kidney injury (%)	10 (5.7)	2 (14.3)	2.319	0.217
Shock
Hypovolemic shock (%)	24 (13.6)	6 (42.9)	11.275	0.011
Septic shock (%)	9 (5.1)	5 (35.7)	22.076	0.001
APACHE II score	11 (8.0-14.0)	15.0 (13.0-33.5)	- 3.059	0.012
SOFA score	2.0 (1.0-3.0)	7.0 (5.0-9.0)	- 4.301	0.001
Non-pulmonary SOFA score	0 (0-1.0)	6.0 (2.0-6.5)	- 4.208	0.001
PaO₂/FiO₂ ratio	207 (136-329)	274 (108-403)	- 0.084	0.704
Duration of ventilation (d)	2.0 (1.0-4.0)	5.0 (2.0-17.5)	- 2.108	0.070
ALI/ARDS (%)	25 (14.2)	5 (35.7)	6.451	0.050

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