Azoulay et al identified factors affecting short term mortality for patients with a solid malignancy being treated in the intensive care unit (ICU). This can help identify those patients who may or may not benefit from more aggressive management. The authors are from Saint Louis Teaching Hospital and University Paris 7.
Time frame for prediction: 30 day mortality
Parameters identified in multivariate analysis:
(1) logistic organ dysfunction (LOD) score > 6
(2) need for mechanical ventilation
(3) history of previous surgical resection of the tumor
|
Parameter |
Odds Ratio |
95% CI |
|
LOD score > 6 |
1.26 |
1.09-1.44 |
|
mechanical ventilation |
3.55 |
1.26 - 6.7 |
|
previous surgical resection |
0.20 |
0.007-0.58 |
from Table 4, page 1821; p value not given for multivariate model
where:
• The LOD score is discussed in section 30.05.
• Factors such as advanced age, metastatic disease, neutropenia or bone marrow transplantation were not predictive of short term mortality.
The authors did not give a way of using this for a specific patient. There are 8 possible combinations, with my interpretation:
|
Mechanical Ventilation |
LOD > 6 |
Surgical Resection |
30-day Prognosis |
|
N |
N |
Y |
very good |
|
N |
N |
N |
good |
|
N |
Y |
Y |
good |
|
N |
Y |
N |
fair |
|
Y |
N |
Y |
fair to poor |
|
Y |
N |
N |
poor |
|
Y |
Y |
Y |
poor |
|
Y |
Y |
N |
very poor |
Specialty: Critical Care, Emergency Medicine, Hematology Oncology, Surgery, general
ICD-10: ,
