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Central neurological complications in critically ill patients with malignancies

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Abstract

Objective

To determine outcomes in critically ill patients hospitalized in the ICU for central neurological complications of cancer.

Design and setting

A 7-year retrospective study.

Subject and intervention

Observational study in 100 critically ill cancer patients with central neurological complications managed using standardized diagnostic and therapeutic strategies.

Measurements and results

There were 52 men and 48 women, aged 55 years (IQR, 40–65). Presenting manifestations were coma (56%), epilepsy (48%), focal signs (35%), encephalopathy (31%), and meningitis (7%). Cerebral imaging was abnormal in 61 patients, lumbar puncture in 17, and electroencephalography in 6. Neurosurgical biopsy was performed on four patients. The main etiologies included drug toxicity in 28, malignant brain infiltration in 21 patients, and cerebrovascular disease in 20. Mechanical ventilation was needed for 60 patients. Anticancer chemotherapy was administered during the ICU stay in 15 patients. ICU and hospital mortalities were 28 and 45%, respectively. By multivariate analysis, independent positive predictors of hospital mortality were poor performance status [odds ratio (OR) 2.94, 95% CI, 1.01–8.55, P = 0.047), focal signs at presentation (OR 3.52, 95% CI, 1.14–10.88, P = 0.029), abnormal lumbar puncture (OR 5.49, 95% CI 1.09–27.66, P = 0.038), and need for vasoactive drugs (OR 6.47, 95% CI 1.32–31.66, P = 0.021), whereas remission of the malignancy (OR 0.20, 95% CI 0.04–0.88, P = 0.033) and GCS score at admission (OR 0.81/point, 95% CI, 0.70–0.95, P = 0.009) were negative predictors of hospital mortality.

Conclusion

In cancer patients, central neurological events are mainly related to malignant brain infiltration and drug-related toxicity. Despite advanced severity, a standardized intensive management strategy yields a 55% hospital survival rate.

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References

  1. Benoit DD, Vandewoude KH, Decruyenaere JM, Hoste EA, Colardyn FA (2003) Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication. Crit Care Med 31:104–112

    Article  PubMed  Google Scholar 

  2. Denier C, Bourhis JH, Lacroix C, Koscielny S, Bosq J, Sigal R, Said G, Adams D (2006) Spectrum and prognosis of neurologic complications after hematopoietic transplantation. Neurology 67:1990–1997

    Article  CAS  PubMed  Google Scholar 

  3. Wen PY, Schiff D (2003) Neurologic complications of solid tumors. Neurol Clin 21:107–140 viii

    Article  PubMed  Google Scholar 

  4. Recht L, Mrugala M (2003) Neurologic complications of hematologic neoplasms. Neurol Clin 21:87–105

    Article  PubMed  Google Scholar 

  5. Seute T, Leffers P, ten Velde GP, Twijnstra A (2004) Neurologic disorders in 432 consecutive patients with small cell lung carcinoma. Cancer 100:801–806

    Article  PubMed  Google Scholar 

  6. Taccone FS, Jeangette SM, Blecic SA (2008) First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis 17:169–174

    Article  PubMed  Google Scholar 

  7. Safdieh JE, Mead PA, Sepkowitz KA, Kiehn TE, Abrey LE (2008) Bacterial and fungal meningitis in patients with cancer. Neurology 70:943–947

    Article  CAS  PubMed  Google Scholar 

  8. Azoulay E, Schlemmer B (2006) Diagnostic strategy in cancer patients with acute respiratory failure. Intensive Care Med 32:808–822

    Article  PubMed  Google Scholar 

  9. Darmon M, Thiery G, Ciroldi M, Porcher R, Schlemmer B, Azoulay E (2007) Should dialysis be offered to cancer patients with acute kidney injury? Intensive Care Med 33:765–772

    Article  PubMed  Google Scholar 

  10. Soares M, Salluh JI, Carvalho MS, Darmon M, Rocco JR, Spector N (2006) Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol 24:4003–4010

    Article  PubMed  Google Scholar 

  11. Pene F, Percheron S, Lemiale V, Viallon V, Claessens YE, Marque S, Charpentier J, Angus DC, Cariou A, Chiche JD, Mira JP (2008) Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med 36:690–696

    Article  PubMed  Google Scholar 

  12. Creput C, Galicier L, Buyse S, Azoulay E (2008) Understanding organ dysfunction in hemophagocytic lymphohistiocytosis. Intensive Care Med 34:1177–1187

    Article  CAS  PubMed  Google Scholar 

  13. Gotay CC, Kawamoto CT, Bottomley A, Efficace F (2008) The prognostic significance of patient-reported outcomes in cancer clinical trials. J Clin Oncol 26:1355–1363

    Article  PubMed  Google Scholar 

  14. Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84

    Article  CAS  PubMed  Google Scholar 

  15. Bateman DE (2001) Neurological assessment of coma. J Neurol Neurosurg Psychiatry 71(suppl 1):i13–i17

    PubMed  Google Scholar 

  16. Straus SE, Thorpe KE, Holroyd-Leduc J (2006) How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? JAMA 296:2012–2022

    Article  CAS  PubMed  Google Scholar 

  17. Kaplan PW (2006) The EEG of status epilepticus. J Clin Neurophysiol 23:221–229

    Article  PubMed  Google Scholar 

  18. Chen JW, Wasterlain CG (2006) Status epilepticus: pathophysiology and management in adults. Lancet Neurol 5:246–256

    Article  PubMed  Google Scholar 

  19. Walker M, Cross H, Smith S, Young C, Aicardi J, Appleton R, Aylett S, Besag F, Cock H, DeLorenzo R, Drislane F, Duncan J, Ferrie C, Fujikawa D, Gray W, Kaplan P, Koutroumanidis M, O’Regan M, Plouin P, Sander J, Scott R, Shorvon S, Treiman D, Wasterlain C, Wieshmann U (2005) Non convulsive status epilepticus: Epilepsy Research Foundation workshop reports. Epileptic Disord 7:253–296

    PubMed  Google Scholar 

  20. Stocchetti N, Beretta L, Citerio G (2009) Criteria for extubation in neurologic patients. Crit Care Med 37:1529 author reply 1529–1530

    Article  PubMed  Google Scholar 

  21. Bellomo R, Ronco C (1998) Indications and criteria for initiating renal replacement therapy in the intensive care unit. Kidney Int Suppl 66:S106–S109

    CAS  PubMed  Google Scholar 

  22. Wen PY, Glantz MJ (2003) Neurologic complications of cancer. Preface. Neurol Clin 21:xi–xiii

    Article  PubMed  Google Scholar 

  23. Legriel S, Azoulay E (2009) Life-threatening neurological complications in patients with malignancies yearbook of intensive care and emergency medicine, pp. 828–844

  24. Azoulay E, Moreau D, Alberti C, Leleu G, Adrie C, Barboteu M, Cottu P, Levy V, Le Gall JR, Schlemmer B (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 26:1817–1823

    Article  CAS  PubMed  Google Scholar 

  25. Staudinger T, Stoiser B, Mullner M, Locker GJ, Laczika K, Knapp S, Burgmann H, Wilfing A, Kofler J, Thalhammer F, Frass M (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328

    Article  CAS  PubMed  Google Scholar 

  26. Plotkin SR, Wen PY (2003) Neurologic complications of cancer therapy. Neurol Clin 21:279–318

    Article  PubMed  Google Scholar 

  27. Sul JK, Deangelis LM (2006) Neurologic complications of cancer chemotherapy. Semin Oncol 33:324–332

    Article  CAS  PubMed  Google Scholar 

  28. DeAngelis LM (2001) Brain tumors. N Engl J Med 344:114–123

    Article  CAS  PubMed  Google Scholar 

  29. Azoulay E, Alberti C, Bornstain C, Leleu G, Moreau D, Recher C, Chevret S, Le Gall JR, Brochard L, Schlemmer B (2001) Improved survival in cancer patients requiring mechanical ventilatory support: impact of noninvasive mechanical ventilatory support. Crit Care Med 29:519–525

    Article  CAS  PubMed  Google Scholar 

  30. Darmon M, Thiery G, Ciroldi M, de Miranda S, Galicier L, Raffoux E, Le Gall JR, Schlemmer B, Azoulay E (2005) Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med 33:2488–2493

    Article  PubMed  Google Scholar 

  31. Darmon M, Azoulay E, Alberti C, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2002) Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients. Intensive Care Med 28:1775–1780

    Article  PubMed  Google Scholar 

  32. Broessner G, Helbok R, Lackner P, Mitterberger M, Beer R, Engelhardt K, Brenneis C, Pfausler B, Schmutzhard E (2007) Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients. Crit Care Med 35:2025–2030

    Article  PubMed  Google Scholar 

  33. Peigne V, Rusinova K, Karlin L, Darmon M, Fermand JP, Schlemmer B, Azoulay E (2009) Continued survival gains in recent years among critically ill myeloma patients. Intensive Care Med 35:512–518

    Article  PubMed  Google Scholar 

  34. Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Vincent JL (2009) Characteristics and outcomes of cancer patients in European ICUs. Crit Care 13:R15

    Article  PubMed  Google Scholar 

  35. Hormigo A, Liberato B, Lis E, DeAngelis LM (2004) Nonconvulsive status epilepticus in patients with cancer: imaging abnormalities. Arch Neurol 61:362–365

    Article  PubMed  Google Scholar 

  36. Thiery G, Azoulay E, Darmon M, Ciroldi M, De Miranda S, Levy V, Fieux F, Moreau D, Le Gall JR, Schlemmer B (2005) Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 23:4406–4413

    Article  PubMed  Google Scholar 

  37. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (saps ii) based on a European/North American multicenter study. JAMA 270:2957–2963

    Article  CAS  PubMed  Google Scholar 

  38. Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D (1996) The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group. JAMA 276:802–810

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Antoinette Wolfe, MD, for helping to prepare the manuscript. Presented in part at the 36th Congress of the French Society for Critical Care (2008), Paris, France.

Conflicts of interest statement

The authors have no conflict of interest.

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Correspondence to Elie Azoulay.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-009-1713-z.

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Legriel, S., Marijon, H., Darmon, M. et al. Central neurological complications in critically ill patients with malignancies. Intensive Care Med 36, 232–240 (2010). https://doi.org/10.1007/s00134-009-1709-8

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