Clinical, Oncological, and Hematological Determinants of In-Hospital Mortality in Critically Ill Patients with Advanced Neoplasia: A Retrospective Cohort Study
- 1Faculty of Medicine and Pharmacy, “Dunărea de Jos” University of Galați, 800008 Galați, Romania
- 2Comrat State University, MD-3805 Comrat, Moldova
- 3Faculty of Medicine and Biological Sciences, ‘Ștefan cel Mare’ University, 720229 Suceava, Romania
Abstract
Background/Objectives: Short-term prognostication remains challenging in critically ill patients with neoplasia. We aimed to retrospectively evaluate the clinical, oncological, and hematological factors associated with in-hospital mortality and its timing in 120 patients with neoplasia admitted to intensive care unit (ICU). Methods: This retrospective cohort included 120 patients admitted to an intensive care unit (ICU). In-hospital mortality was analyzed using Firth penalized logistic regression with adjustment for Acute Physiology and Chronic Health Evaluation II (APACHE II) scores recorded at ICU admission. Time to death was analyzed using Cox regression and Fine–Gray competing-risk regression. Predictive performance was internally validated using 1000 bootstrap resamples, with calibration and exploratory decision-curve analyses. Results: Mortality was 80.0%. After APACHE II adjustment, hepatic metastases remained associated with mortality (adjusted odds ratio [aOR] 7.87, 95% confidence interval [CI] 2.41–29.44), whereas platelet count was inversely associated (aOR 0.82 per 50 × 109/L, 95% CI 0.69–0.94). Neutrophil-to-lymphocyte ratio (NLR) was not significantly associated with binary mortality. In APACHE II-adjusted Fine–Gray analysis, NLR (subdistribution hazard ratio [sHR] 1.20 per doubling, 95% CI 1.03–1.40) and platelet count (sHR 0.90, 95% CI 0.84–0.97) were associated with the cumulative incidence of death. Adding platelet count increased the optimism-corrected area under the receiver operating characteristic curve (AUROC) from 0.743 to 0.799 in the original clinical model (ΔAUROC 0.056, 95% CI 0.002–0.146); after APACHE II adjustment, the gain was uncertain (0.745 to 0.793; ΔAUROC 0.048, 95% CI −0.0003–0.128). Conclusions: Hepatic metastases and platelet count retained prognostic associations after severity adjustment.
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BibTeX
@article{platica2026clinical,
title = {{Clinical, Oncological, and Hematological Determinants of In-Hospital Mortality in Critically Ill Patients with Advanced Neoplasia: A Retrospective Cohort Study}},
author = {Valeriu Plătică and Iulia Chiscop and Adina Plătică and Magdalena Miulescu and Corina-Cecilia Manole Pălivan and Anamaria Hărăbor and Dorel Firescu and Mihaela Lungu and Ingrid-Andrada Vasilache and Laura-Florentina Rebegea},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218669},
url = {https://www.mdpi.com/2077-0383/15/21/8669},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Clinical, Oncological, and Hematological Determinants of In-Hospital Mortality in Critically Ill Patients with Advanced Neoplasia: A Retrospective Cohort Study
AU - Valeriu Plătică
AU - Iulia Chiscop
AU - Adina Plătică
AU - Magdalena Miulescu
AU - Corina-Cecilia Manole Pălivan
AU - Anamaria Hărăbor
AU - Dorel Firescu
AU - Mihaela Lungu
AU - Ingrid-Andrada Vasilache
AU - Laura-Florentina Rebegea
PY - 2026
DA - 2026/11/06
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218669
UR - https://www.mdpi.com/2077-0383/15/21/8669
AB - Background/Objectives: Short-term prognostication remains challenging in critically ill patients with neoplasia. We aimed to retrospectively evaluate the clinical, oncological, and hematological factors associated with in-hospital mortality and its timing in 120 patients with neoplasia admitted to intensive care unit (ICU). Methods: This retrospective cohort included 120 patients admitted to an intensive care unit (ICU). In-hospital mortality was analyzed using Firth penalized logistic regression with adjustment for Acute Physiology and Chronic Health Evaluation II (APACHE II) scores recorded at ICU admission. Time to death was analyzed using Cox regression and Fine–Gray competing-risk regression. Predictive performance was internally validated using 1000 bootstrap resamples, with calibration and exploratory decision-curve analyses. Results: Mortality was 80.0%. After APACHE II adjustment, hepatic metastases remained associated with mortality (adjusted odds ratio [aOR] 7.87, 95% confidence interval [CI] 2.41–29.44), whereas platelet count was inversely associated (aOR 0.82 per 50 × 109/L, 95% CI 0.69–0.94). Neutrophil-to-lymphocyte ratio (NLR) was not significantly associated with binary mortality. In APACHE II-adjusted Fine–Gray analysis, NLR (subdistribution hazard ratio [sHR] 1.20 per doubling, 95% CI 1.03–1.40) and platelet count (sHR 0.90, 95% CI 0.84–0.97) were associated with the cumulative incidence of death. Adding platelet count increased the optimism-corrected area under the receiver operating characteristic curve (AUROC) from 0.743 to 0.799 in the original clinical model (ΔAUROC 0.056, 95% CI 0.002–0.146); after APACHE II adjustment, the gain was uncertain (0.745 to 0.793; ΔAUROC 0.048, 95% CI −0.0003–0.128). Conclusions: Hepatic metastases and platelet count retained prognostic associations after severity adjustment.
SN - 2077-0383
ER -