Characteristics and Outcomes of DNR Patients Admitted to an Oncologic ICU

Abstract

PURPOSE: DNR status may influence ICU triage decisions; ICU admission is often based on the presumed reversibility of the acute condition. The purpose of this study was to examine the outcome of cancer patients with DNR orders at the time of ICU consultation who were admitted to the ICU and compare the characteristics of survivors and non-survivors. METHODS: Using hospital and ICU databases, we retrospectively studied patients with DNR orders at the time of ICU admission from 2007 to 2009. Data collected included: age, gender, admitting service, Mortality Probability Model (MPM) II and APACHE II scores on ICU admission, type of cancer (solid or hematologic), vasopressor use, ventilator support, CRRT, DNR reversal, withdrawal of care, ICU and hospital LOS, and ICU survival. Data are presented as mean (+SD), absolute numbers and percentages. Characteristics of survivors and non-survivors were compared using Pearson chi-square test. P value < 0.05 was significant. RESULTS: During the 3-year study period, there were 2,890 ICU consultations; 186 (6.43%) had DNR orders. Of these 58 (31%) patients were admitted to the ICU. The ICU survival rate of these patients was 74%. The characteristics of ICU survivors and non-survivors were similar except for significantly lower MPM II and APACHE II scores and lower lactate level among survivors. Non-survivors had higher rates of withdrawal of care. CONCLUSIONS: The majority of cancer patients with DNR orders at the time of ICU admission survive to ICU discharge. Only the severity of illness reliably predicted outcome in this population. CLINICAL IMPLICATIONS: Cancer patients with DNR orders should be considered for ICU admission based on the severity of their critical illness.