{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T23:28:18Z","timestamp":1777073298076,"version":"3.51.4"},"reference-count":31,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,16]],"date-time":"2022-06-16T00:00:00Z","timestamp":1655337600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: To analyze the long-term outcomes for advanced cancer patients admitted to an intermediate care unit (ImCU), an analysis of a do not resuscitate orders (DNR) subgroup was made. Methods: A retrospective observational study was conducted from 2006 to January 2019 in a single academic medical center of cancer patients with stage IV disease who suffered acute severe complications. The Simplified Acute Physiology Score 3 (SAPS 3) was used as a prognostic and severity score. In-hospital mortality, 30-day mortality and survival after hospital discharge were calculated. Results: Two hundred and forty patients with stage IV cancer who attended at an ImCU were included. In total, 47.5% of the cohort had DNR orders. The two most frequent reasons for admission were sepsis (32.1%) and acute respiratory failure (excluding sepsis) (38.7%). Mortality in the ImCU was 10.8%. The mean predicted in-hospital mortality according to SAPS 3 was 51.9%. The observed in-hospital mortality was 37.5% (standard mortality ratio of 0.72). Patients discharged from hospital had a median survival of 81 (30.75\u2013391.25) days (patients with DNR orders 46 days (19.5\u201392.25), patients without DNR orders 162 days (39.5\u2013632)). The observed mortality was higher in patients with DNR orders: 52.6% vs. 23.8%, p 0 &lt; 0.001. By multivariate logistic regression, a worse ECOG performance status (3\u20134 vs. 0\u20132), a higher SAPS 3 Score and DNR orders were associated with a higher in-hospital mortality. By multivariate analysis, non-invasive mechanical ventilation, higher bilirubin levels and DNR orders were significantly associated with 30-day mortality. Conclusion: For patients with advanced cancer disease, even those with DNR orders, who suffer from acute complications or require continuous monitoring, an ImCU-centered multidisciplinary management shows encouraging results in terms of observed-to-expected mortality ratios.<\/jats:p>","DOI":"10.3390\/jcm11123472","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T05:25:11Z","timestamp":1655443511000},"page":"3472","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Long-Term Outcome of Critically Ill Advanced Cancer Patients Managed in an Intermediate Care Unit"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6978-1659","authenticated-orcid":false,"given":"Nerea","family":"Fern\u00e1ndez Ros","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F\u00e9lix","family":"Alegre","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Rodr\u00edguez Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Oncology, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3234-8805","authenticated-orcid":false,"given":"Manuel F.","family":"Landecho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain"},{"name":"Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Sunsundegui","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso","family":"G\u00farpide","sequence":"additional","affiliation":[{"name":"Department of Oncology, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8850-8866","authenticated-orcid":false,"given":"Ram\u00f3n","family":"Lecumberri","sequence":"additional","affiliation":[{"name":"Hematology Service, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Sanz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, European University of Madrid, 28670 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicol\u00e1s","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain"},{"name":"Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Quiroga","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain"},{"name":"Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red Enfermedades Hep\u00e1ticas y Digestivas (CIBERehd), 28801 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4999-6753","authenticated-orcid":false,"given":"Juan Felipe","family":"Lucena","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Intermediate Care and Hospitalists Unit, Clinica Universidad de Navarra, 31008 Pamplona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2225","DOI":"10.1002\/cncr.32802","article-title":"Annual report to the nation on the status of cancer, part I: National cancer statistics","volume":"126","author":"Henley","year":"2020","journal-title":"Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/cc7713","article-title":"Characteristics and outcomes of cancer patients in European ICUs","volume":"13","author":"Taccone","year":"2009","journal-title":"Crit. 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