-
[show abstract]
[hide abstract]
ABSTRACT: To develop and validate a model for probability of hospital mortality for cancer patients at 72 h of intensive care unit (ICU) management.
This is an inception cohort study performed at four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU. A preliminary model was developed from 827 patients and then validated on an additional 415 patients. Multiple logistic regression modeling was used to develop the models, which were subsequently evaluated for discrimination and calibration. The main outcome measure is in-hospital death.
A probability of mortality model, which incorporates ten discrete categorical variables, was developed and validated. All variables were collected at 72 h of ICU care. Variables included evidence of disease progression, performance status before hospitalization, heart rate >100 beats/min, Glasgow coma score </=5, mechanical ventilation, arterial oxygen pressure/fractional inspiratory oxygen ( PaO(2)/FiO(2)) ratio <250, platelets <100 k/ micro l, serum bicarbonate (HCO(3))<20 mEq/l, blood urea nitrogen (BUN) >40 mg/dl, and a urine output of <150 ml for any 8 h in the previous 24 h. The p values for the fit of the preliminary and validation models were 0.535 and 0.354 respectively, and the areas under the receiver operating characteristic (ROC) curves were 0.809 and 0.820.
We report a multivariable logistic regression model to estimate the probability of hospital mortality in critically ill cancer patients at 72 h of ICU care. The model is comprised of ten unambiguous and readily available variables. When used in conjunction with clinical judgment, this model should improve discussions about goals of care of these patients. Additional validation in a community hospital setting is warranted.
Supportive Care Cancer 11/2003; 11(11):686-95. · 2.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: GoalsTo develop and validate a model for probability of hospital mortality for cancer patients at 72h of intensive care unit (ICU) management.Patients and methodsThis is an inception cohort study performed at four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU. A preliminary model was developed from 827 patients and then validated on an additional 415 patients. Multiple logistic regression modeling was used to develop the models, which were subsequently evaluated for discrimination and calibration. The main outcome measure is in-hospital death.ResultsA probability of mortality model, which incorporates ten discrete categorical variables, was developed and validated. All variables were collected at 72h of ICU care. Variables included evidence of disease progression, performance status before hospitalization, heart rate >100beats/min, Glasgow coma score 5, mechanical ventilation, arterial oxygen pressure/fractional inspiratory oxygen (PaO2/FiO2) ratio <250, platelets <100k/l, serum bicarbonate (HCO3)<20mEq/l, blood urea nitrogen (BUN) >40mg/dl, and a urine output of <150ml for any 8h in the previous 24h. The p values for the fit of the preliminary and validation models were 0.535 and 0.354 respectively, and the areas under the receiver operating characteristic (ROC) curves were 0.809 and 0.820.ConclusionsWe report a multivariable logistic regression model to estimate the probability of hospital mortality in critically ill cancer patients at 72h of ICU care. The model is comprised of ten unambiguous and readily available variables. When used in conjunction with clinical judgment, this model should improve discussions about goals of care of these patients. Additional validation in a community hospital setting is warranted.
Supportive Care Cancer 01/2003; 11(11):686-695. · 2.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report the results of a dose-intense chemotherapy regimen designed to rapidly induce remissions in patients with advanced multiple myeloma (MM). Patients received VAD for 3-6 cycles depending on response kinetics. This was followed by three sequential cycles of cyclophosphamide (CTX) at 3 g/m2 every 15 days with G-CSF support. 71% of these patients had stage IIIa, 23% had renal failure. The median age was 58, median beta-2 microglobulin 4.6 and median albumin was 3.5, indicating poor prognosis. Of 35 patients, 66% achieved a complete response (CR) (SWOG). Six patients (18%) had a partial response. Fifty percent of the patients with renal failure recovered their kidney function. High-dose CTX contributed to tumor-mass reduction particularly in patients presenting with high-tumor burden. Tumor-mass reduction following three pulses of dexamethasone (4 days each) is significantly higher than with one pulse (p < 0.005). While high beta-2 microglobulin and LDH levels (p < 0.05) were associated with poor outcome, patients who responded faster to chemotherapy had a longer survival (p = 0.005). We conclude that this regimen is safe and effective. A rapid response may be useful in selecting patients who may benefit from further high dose chemotherapy and stem cell support.
Leukemia and Lymphoma 04/2002; 43(3):607-12. · 2.58 Impact Factor
