Clinical Deterioration Among Patients Hospitalized at a Tertiary Cancer Hospital
In a study reported in the Journal of Oncology Practice, Lyons et al found that transfer to the intensive care unit (ICU) or on-ward death occurred in 9% of admissions to cancer wards at an urban tertiary cancer hospital. Investigators identified factors associated with clinical deterioration resulting in these events.
Study Details
The retrospective cohort study included data from 21,219 consecutive admissions to oncology wards among 9,058 patients at Barnes-Jewish Hospital in St. Louis, a National Cancer Institute (NCI)-designated comprehensive cancer center, between January 2014 and June 2017. Clinical deterioration was defined as the composite of ward death and transfer to the ICU. Risk factors for deterioration were assessed by logistic regression analysis.
Key Findings
The composite outcome occurred during 1,945 admissions (9.2%): 1,365 (6.4%) involved one or more ICU transfer and 580 (2.7%) involved ward death.
Independent risk factors for clinical deterioration included:
- Age: odds ratio [OR] = 1.33 per decade, 95% confidence interval [CI] = 1.07–1.67
- Male sex: OR = 1.15, 95% CI = 1.05–1.33
- Comorbidities or illness severity: OR = 1.11, 95% CI = 1.10–1.13
- Emergency admission: OR = 1.45, 95% CI = 1.26–1.67
- Hospitalization on particular wards: OR = 1.525, 95% CI = 1.33–1.67
- Bacteremia: OR = 1.24, 95% CI = 1.01–1.52
- Fungemia: OR = 3.76, 95% CI = 1.90–7.41
- Tumor lysis syndrome: OR = 3.01, 95% CI = 2.41–3.76
- Receipt of antimicrobials: OR = 2.04, 95% CI = 1.72–2.42
- Receipt of transfusions: OR = 1.65, 95% CI = 1.42–1.92.
The investigators noted that, as an NCI-designated comprehensive cancer center, the institution may serve a population of patients with more severe or atypical cancer presentations than other hospitals.
They concluded, “Clinical deterioration was common; it occurred in more than 9% of admissions. Factors independently associated with deterioration included comorbidities, admission source, infections, and blood product transfusion.”
Patrick G. Lyons, MD, of the Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, is the corresponding author for the Journal of Oncology Practice article.
Disclosure: The study was supported by grants from the National Institutes of Health and by the Barnes-Jewish Hospital Foundation. For full disclosures of the study authors, visit jop.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
