Table 2.
Detailed description of studies included (n = 49)
| Author, year | Country | Methods | Population | Sample Size | Age, years (Mean, SD, or Median) | % Male | Cancer Studied | Oncologic Emergency Studied | Intervention Used in the ED/Hospital |
|---|---|---|---|---|---|---|---|---|---|
| Abelson et al., 2017 [29] | United States | Retrospective Observational Cohort Study | Patients admitted to the ED with MLBO who were treated with palliative stent (n = 172) or stoma (n = 173) | 345 | 69.9 (14.4) (stoma group), 70.9 (16.8) (stent group) | 87 (50.3%, stoma); 90 (52.3% stent) | Colorectal | palliation of malignant large-bowel obstruction (MLBO) | Palliative stenting or stoma creation |
| Alsirafy et al., 2016 [30] | Other: Egypt | Retrospective Observational Cohort Study | Patients with terminal cancer who died at KAMC-HC during the 13-month period | 154 | Median (range): 60 (16–91) | 69 (44.8%) | All | Pain, dyspnea, vomiting | n/a |
| Azoulay et al., 2021 [31] | Other: France, Spain, USA, UK, Russia, Canada, Germany, Austria | Retrospective Observational Cohort Study | Patients who received CAR T-cell therapy in the past 30 days had been admitted to the ICU for any reason | 241 | Median (range): 58 (43–66) | 144 (60%) | All hematological malignancies | Isolated cytokine release syndrome, sepsis (due to pneumonia, enterocolitis, and skin and soft tissue infections), frailty | Life-saving treatments (vasoactive drugs), non-invasive ventilation or high-flow nasal oxygen, steroid therapy, |
| Banala et al., 2020 [32] | United States | Randomized Clinical Trial | Adult patients with cancer presenting with severe pain to the ED | 84 | Median (range): IV Hydromorphone group: 51 (29–78); Intranasal Fentanyl group)55 (22–84) | 36 (43.9%) | All | Severe pain | Intranasal fentanyl (INF) vs intravenous hydromorphone (IVH) |
| Bosscher et al., 2016 [33] | Other: The Netherlands | Prospective Observational Cohort Study | Adult cancer patients (age [18 years) in the University Medical Center Groningen who required surgical consultation for oncologic emergencies | 207 | Not reported | 101 (48.8%) | All | Obstruction, infection, clinical deterioration, gastrointestinal perforation, bleeding/thrombosis, pathological fractures | Referral to surgery within 30 days after emergency evaluation or non-surgical treatment |
| Bou Chebl et al., 2021 [34] | Other: Lebanon | Retrospective Observational Cohort Study | All patients > 18 years of age admitted with sepsis | 442 | 67.92 (13.32, solid tumor); 55.37 (20.85, hematological malignancy) | 190 (62.3% solid); 97 (70.8% hematological) | All | Sepsis | IV fluids, Vasopressor use, steroid use, intubation |
| Bow et al., 2006 [35] | Other: USA, Canada, Australia | Randomized Clinical Trial | Patients at high risk for medical complications who were > = 18 years old, severely neutropenic, hospitalized for the management of a febrile episode complicating the course of cytotoxic therapy for a hematological malignancy or for a hematopoietic stem cell transplant (HSCT), and who had provided written, informed consent according to institutional protocol | 264 | 50.2 (15.1, Piperacillin-tazobactam recipients); 50.1 (14.5, Cefepime recipients) | 166/265 (62.6% Piperacillin-tazobactam recipients); 146/263 (54.4% Cefepime recipients) | All Hematological malignancies | Febrile neutropenic episodes | n/a |
| Castillo et al., 2021 [36] | United States | Retrospective Observational Cohort Study | Patients receiving ICI therapy within 6 weeks before ED presentation who had a contemporary evaluation in the Mayo Clinic Hospital ED between May 1, 2017, and April 30, 2018 | 67 | Median (range): 65 (24–88) | 36 (53.7%) | All | Immune-related adverse events (abdominal pain, colitis, diarrhea, hyperglycemia, shortness of breath, dizziness, chest pressure/tightness, nausea and vomiting) | Corticosteroids (dexamethasone 10 mg, prednisone 60 mg) |
| Cauley et al., 2015 [37] | United States | Retrospective Observational Cohort Study | Patients included in this study were at least 18 years old, had a preoperative diagnosis of disseminated cancer and Patients who underwent an emergency operation for intestinal obstruction or perforation by the primary DRG International Classification of DiseasesV9th Rev. (ICD-9) code | 875 | Not reported | 52% (in intestinal perforation group); 51% (in Obstruction group) | All | Intestinal Obstruction or Perforation | Emergency Operation |
| Chou et al., 2012 [38] | Other: Taiwan | Retrospective Observational Cohort Study | Consecutive patients with stage III to stage IV lung cancer, who were admitted to ICU for sepsis-related respiratory failure | 70 | 71.7 (12.3, survived to hospital discharge); 76.4 (11.6, died) | 23 (79.3% survived to hospital discharge); 37 (90.2% died) | Lung, stage III and IV | Sepsis-related respiratory failure | Intubated via mechanical ventilator support. If patients failed to be weaned from the ventilator, they were transferred to a respiratory care facility for long-term ventilator support |
| Cooksley et al., 2020 [39] | UK | Prospective Observational Cohort Study | All emergency presentations in patients treated with ICIs within 6 months before admission were seen at a specialist oncology hospital in England from 20th May 2018 to 19th May 2019 | 300 | Median (range): 67 (28–88) | 185 (61.7%) | All | Dyspnea, diarrhea, and fever related to ICI toxicity | Steroids, antibiotics |
| Coyne et al., 2021 [40] | United States | Prospective Observational Cohort Study | Adults 18 years or older with active cancer presenting to the ED | 1075 | Median (range): 64 (19–90) | 518 (48.2%) | All | Pain | Opioids, acetaminophen |
| Delgado-Guay et al., 2015 [41] | United States | Retrospective Observational Cohort Study | Patients with advanced cancer aged 18 years or older who visited the ED after their first visit to an outpatient palliative care clinic | 200 | 56.5 (13.6) | 104 (52%) | All | pain, GI symptoms, altered mental status, other neurologic symptoms, infection, dyspnea, fever/chill, bleeding, edema/swelling, constipation, general weakness, fell down | received palliative care consultation in the ED or admitted to the hospital |
| DeSilva, Jackson, and Steer, 2018 [42] | Australia | Retrospective Observational Cohort Study | Patients ≥ 18 years of age who were admitted under the oncology unit at Albury Wodonga Health during a 12-month period and who had a microbiological test performed for suspected infection during their admission | 208 | Median (range): 67 (19–89, with febrile neutropenia); 68 (19–89, without febrile neutropenia) | 28 (56% with febrile neutropenia); 99 (62.7%, without febrile neutropenia) | All | Infection, neutropenic fever episodes | Antibiotic therapy |
| Frago et al., 2010 [43] | Other: Spain | Retrospective Observational Cohort Study | Patients with stage IV obstructing CRC presenting to the ED | 55 | 65.5 (50–77, surgery group); 65.9 (19–84, stent group) | 9/12 (75% surgery group); 32/43 (74.41%, stent group) | Colorectal, stage IV | Bowel obstruction | Colonic stenting or palliative chemotherapy (consisting of a combi-nation of 5-fluorouracil (5-FU), leucovorin (LV), and irino-tecan (FOLFIRI) or oxaliplatin (FOLFOX)) |
| Giustozzi et al., 2021 [44] | Other: Italy, USA, Belgium, France, Germany, Israel, Netherlands, UK, Poland, and Spain | Randomized Clinical Trial | Patients with cancer with symptomatic or incidental acute proximal deep vein thrombosis or pulmonary embolism were randomized in a 1:1 ratio to receive oral apixaban or subcutaneous dalteparin | 1155 | 67.3 (11.0, incidental VTE); 68 (11.2, Symptomatic VTE) | 115 (50%, incidental VTE); 453 (49%, symptomatic VTE) | All | Incidental or symptomatic acute proximal deep venous thromboembolism (VTE) | Lab testing, diagnostic imaging |
| Grewal et al., 2020 [45] | Canada | Retrospective Observational Cohort Study | Patients aged 18 years and older with a cancer diagnosis and who received chemotherapy in the 30 days before being seen in an emergency department between 2013 and 2017 | 87,555 | 66 (56–74) | 39,383(45%) | All | Infection, fever, gastrointestinal diagnoses | Specialty consultation, hospital admission |
| Gudiol et al., 2016 [46] | Other: Spain | Prospective Observational Cohort Study | Advanced solid neoplasm was considered in patients with confirmed metastatic disease (stage IV) and some tumors in stage III (lung, pancreas, gastric, esopha-geal and urothelial) not suitable for curative treatment | 795 | 64 (29–89) | 35 (63.6%) | All | Bacteremic pneumonia in neutropenic cancer patients, fever, cough, septic shock, | ICU admission, invasive mechanical ventilation, antibiotic therapy, targeted antibiotic therapy |
| Hsu et al., 2021 [47] | Other: Taiwan | Retrospective Observational Cohort Study | Adults with cancer who received palliative care during the final 6 months of their life | 762 | 70.4 (13.0) | 44 (49.4%) | All | Anemia, altered mental status, catheter-related events, dyspnea, falls, fever, N/V or other GI symptoms, pain, and tumor bleeding/complications | n/a |
| Kao et al., 2018 [48] | Other: Taiwan | Case–Control Study | Advanced cancer patients receiving palliative home care services | 65 | 72.6 (12.1) | 35 (54.8) | All | Pain, infection or fever, nausea or vomiting, constipation, dyspnea, change of consciousness, and gastrointestinal bleeding | Morphine |
| Kerhuel et al., 2015 [49] | Other: France | Retrospective Observational Cohort Study | All patients admitted to the ICU within the 3 months following HDT/ASCT during the study period | 27 | 54 (38–60) | 14 (52%) | Lymphoma | Infection, shock, acute respiratory failure, neurologic disorder, bleeding | Vasopressors, invasive mechanical ventilation, non-invasive mechanical ventilation, renal replacement therapy |
| Kim et al., 2014 [50] | Other: Korea | Retrospective Observational Cohort Study | Patients with pathologically confirmed lung cancer who were admitted to the medical ICU at Seoul National Uni-versity Bundang Hospital between 2003 and 2011 | 95 | 65.6 (10.3) | 78 (82%) | Lung, stage IIIB and IV | Obstructive pneumonia, respiratory failure due to lung involvement of cancer, cardiac tamponade, tumor bleeding, neurologic events, metabolic events, radiation pneumonitis, chemo-induced lung toxicity, infection with neutropenia, infection without neutropenia, other complications due to treatment, neutropenic septic shock, comorbidity related events | Vasoactive agents, hemodialysis, CPR, mechanical ventilation |
| Klamroth et al., 2022 [51] | Other: Germany | Prospective Observational Cohort Study | Patients diagnosed with cancer-associated venous thrombosis with newly diagnosed symptomatic or asymptomatic VTE, pulmonary embolism (PE), or deep vein thromboses (DVT) and age ≥ 18 years | 382 | Median is 67 years for patients with CAT | 189 (49.5%, patients with CAT) | All | Cancer-associated venous thrombosis (CAT) | Anticoagulant therapy with low-molecular weight heparin, direct oral anticoagulants, Vit K antagonists, unfractionated heparin |
| Lagman et al., 2007 [52] | United States | Prospective Observational Cohort Study | Patients who were admitted to The Harry R. Horvitz Acute Inpatient Palliative Medicine Unit with an episode needing acute inpatient treatment for symptom control or management of complications | 96 | 62 (31–92) | 48 (50%) | All | Acute inpatient treatment of symptom control and cancer-related complications (i.e., neutropenic fever, radiation-induced pneumonitis, intractable emesis), terminal care, antineoplastic therapy-induced complications, comorbid condition related symptoms | Invasive diagnostic (i.e., endoscopy) and therapeutic procedures, medications (i.e., opioids, laxatives, acid suppressants, corticosteroids, antiemetics), hydration, transfusions, radiation or chemo or a combination, discharged home with hospice care, lab tests, radiologic investigations |
| Mercadante et al., 2010 [53] | Other: Italy | Prospective Observational Cohort Study | Patients consecutively admitted to a Pain Relief and Palliative Care unit in a period of 6 months from January 2008 to June 2008, who were receiving opioids in doses of oral morphine equivalents equal to or more than 60 mg daily or who were prescribed opioids for breakthrough pain (BTP) of different nature | 66 | 66.7 (12.2) | 42 (63.6%) | All | Pain | Opioids intravenous, oral, transdermal |
| Mercadante et al., 2017 [54] | Other: Italy | Prospective Observational Cohort Study | Advanced cancer patients who were admitted to an APSCU | 235 | 66.7 (11.9, first admission); 62.7 (11.9, readmission) | 134 (57%, first admission); 48 (60.8% readmissions) | All | Uncontrolled pain, opioid-induced toxicity, chemotherapy-induced toxicity, symptom control, and end-of-life care | Opioid therapy |
| Miranda et al., 2016 [55] | Other: Brazil | Cross-Sectional Study | Patients with cancer treated at oncological service and attended an ED for oncologic monitored from September 2011 to December. 2011, with length of stay > 2 h, aged 18 years or older | 191 | Not reported | 68 (35.6) | All | Infection, pain, GI symptoms, respiratory symptoms, | n/a |
| Moghnieh et al., 2015 [56] | Other: Lebanon | Retrospective Observational Cohort Study | Adult cancer patients with fever and neutropenia, including those undergoing Hematopoietic Stem Cell Transplantation (HSCT), with positive blood cultures were selected | 70 | Not reported | 36 (48%) | All | Febrile neutropenia | n/a |
| Numico et al., 2015 [57] | Other: Italy | Retrospective Observational Cohort Study | Patients admitted to the General Valle d’Aosta Hospital inpatient oncology ward between August 1, 2011 and December 31 2012 | 454 | 69.2 (26–92) | 258 (56.9%) | All | Breathlessness, pain, fever, intestinal obstruction, other digestive symptoms (nausea and vomiting, jaundice, diarrhea, dysphagia, etc.), neurological symptoms (mainly related to brain metastases or meningeal carcinomatosis), general symptoms (such as fatigue and cachexia) and cardiovascular symptoms (such as those related to deep vein thrombosis, pericardial effusion, heart failure) | Imaging, antitumor interventions, antibiotics, opiates, diagnostic or therapeutic invasive procedures (thoracentesis for pleural effusion or biliary drainage for obstruction), chemotherapy or radiotherapy, transferred to hospice, or in-hospital death |
| Patel et al., 2017 [58] | United States | Retrospective Observational Cohort Study | Opioid-tolerant cancer patients > 18 years old who presented to two urban tertiary-care EDs between January 1, 2012 and November 30, 2014 and received opioids for the management of acute pain | 216 | Mean (range): 58 (29–89) | 92 (42.40%) | All | Pain | Opioids |
| Peyrony et al., 2021 [59] | Other: France | Cross Sectional Study | Patients of 18 years or older with solid or hematologic malignancy | 1081 | 72 (62–82) | 611 (56.52%) | All | Dyspnea, neurological disorder, and fatigue | Ultrasound, blood tests, ECG, venous access, oxygen therapy, mechanical ventilation, existing tracheostomy use, fluid challenge, catecholamines, analgesia, morphine, CPR, sedation, antibiotics, |
| Poutsiaka et al., 2007 [60] | United States | Prospective Observational Cohort Study | All patients receiving daptomycin resided on the Bone Marrow Transplant Units of the two participating institutions (Tufts-New England Medical Center, Boston Massachusetts and the University of Iowa Hospital, Iowa City, Iowa) from 2000 to 2002 | 9 | Mean (range): 52.9 (25–70) | 7/9 (77.8%) | All hematological malignancies | Treating VRE BSI in febrile neutropenic patients | Daptomycin |
| Raghavendra et al., 2014 [61] | United States | Retrospective Observational Cohort Study | Patients with neutropenic fever with fever > 38.8 degrees Celsius | 215 | Median is 69 years | Not reported | All | Neutropenic fever | Antibiotics and infectious disease consult service use |
| Rolston et al., 2010 [62] | United States | Prospective Observational Cohort Study | Patients with neutropenic fever | 21 | 44 (24–84) | 4 (19%) | All solid tumors | Neutropenic fever | Physical exam, lab tests, oral moxifloxacin |
| Ruiz-Artacho et al., 2018 [63] | Other: USA, Argentina, Austria, Belgium, Brazil, China, Colombia, Czechia, Ecuador, Egypt, France, Germany, Greece, Honduras, Iran, Ireland, Israel, Italy, Japan, Latvia, Morocco, North Macedonia, Portugal, Spain, Switzerland, UK, Vietnam, | Prospective Observational Cohort Study | Patients with biopsy-proven active cancer in the lung presenting with acute symptomatic, objectively confirmed VTE | 1725 | 65 (12.0, both pulmonary embolism and deep VT groups) | 873 (72%, Pulmonary embolism); 377 (73%, Deep VT) | Lung | Recurrent DVT, or PE and major bleeding | Anticoagulant therapy, repeat compression ultrasonography, helical CT pulmonary, ventilation–perfusion lung scintigraphy, angio-graphy, or pulmonary angiography |
| Sandgren et al., 2010 [64] | Other: Sweden | Cross Sectional Study | Palliative cancer patients | 520 | 70 (62, 71, 79 quartiles, 2002 DATA); 74 (67, 76, 83, 2007) | 107 (55.7%, 2002); 182 (55.5%, 2007) | All | Pain, deterioration, nausea, infection | n/a |
| Skiba et al., 2020 [65] | Australia | Retrospective Observational Cohort Study | Adult cancer patients with a recorded diagnosis of neutropenic fever who were hospitalized at a tertiary care hospital between January 2017 and December 2017 | 88 | 64 (12.25) | 31 (35.2) | All solid tumors | Neutropenic fever | Antibiotics |
| Soares, Martins, and Uchoa, 2003 [66] | Other: Brazil | Prospective Observational Cohort Study | Patients with severe cancer pain admitted to our palliative care center’s emergency room between April 2001 and June 2002 and aged between 18 and 80, on concurrent morphine therapy for at least 2 weeks, and had severe pain at initial assessment | 18 | 51 (34–74) | 10 (55.5%) | All solid tumors | Severe pain | IV fentanyl |
| Sutradhar, Barbera, and Seow, 2017 [67] | Canada | Retrospective Observational Cohort Study | Each decedent had to be at least 18 years of age at cancer diagnosis and had to have received homecare nursing (with standard or palliative intent) prior to their date of death | 54,743 | Not reported | 26,913 (47.9%) | All | Dyspnea, malaise and fatigue, acute abdominal or pelvic pain, fever with chills, pain in throat, projectile vomiting, nausea, disorientation, rheumatism or other soft-tissue disorders, panniculitis affecting regions of next and back multiple sites in spine | n/a |
| Teimouri et al., 2022 [68] | Canada | Retrospective Observational Cohort Study | Adult medical oncology patients (≥ 18 years of age) with an NSH-CZ postal code who had received at least one dose of nivolumab, ipilimumab, or the nivolumab plus ipilimumab combination for cancer treatment at the Victoria General Hospital | 129 | 64 (11.0) | 84 (65.1%) | All | Diarrhea/colitis, hepatitis, pneumonitis, nephrotoxicity, and cardiotoxicity | Steroids |
| Verhoef et al., 2020 [69] | Other: Netherlands | Retrospective Observational Cohort Study | Adult patients who visited the ED between May 2011 and June 2014, included those who were in the palliative phase of cancer at the moment of the ED visit and died within 3 months thereafter | 420 | 63 (22–92) | 229 (54.5%) | All | Dyspnea, pain, and ascites | Imaging and blood tests, EOL goals of care discussions, hospitalizations |
| Verhoef et al., 2020 [70] | Other: Netherlands | Retrospective Observational Cohort Study | All adult patients with HM who died within 3 months after their last ED visit were included. They were compared to patients. with ST having advanced cancer, which was defined as not having any curative options or receiving anticancer treatment not aimed at curation | 498 | 63 (22–94, all); 61 (27–94, HM); 61 (22–92, ST) | 282 (56.6%, all); 53/78 (67.9%, HM); 229/420 (54.5%, ST) | All | Dyspnea, pain, fever, nausea or vomiting, neurologic deterioration, weakness or loss of strength, bleeding, obstipation or diarrhea, fatigue, difficulty swallowing or passage problems, seizure, edema, ascites | Diagnostic imaging, laboratory tests, hospitalization |
| Waddle et al., 2015 [71] | United States | Retrospective Observational Cohort Study | Cancer patients who initiated external beam RT at the University of North Carolina at Chapel Hill from January 1, 2010, through December 31, 2010 | 1116 | Not reported | 534 (47.85%) | All | GI symptoms, neurologic symptoms, respiratory symptoms, pain, fever or infection | n/a |
| Won et al., 2014 [72] | Other: Korea | Retrospective Observational Cohort Study | Patients aged 20 years and older, who stayed in the CED for more than 24 h and experienced pain with self-reported numeric rating scale (NRS) scores of 4 or greater at the time of admission or during the CED stay | 455 | 53.9 (11.9, before CPCP); 56.2 (11.4, after CPCP) | 81 (50%, before CPCP); 159 (55%, after CPCP) | All | Pain | Regular, time-release analgesics and immediate-release analgesics |
| Woon et al., 2021 [73] | Canada | Retrospective Observational Cohort Study | All men aged 66 and older who received abiraterone or enzalutamide as first-line (chemotherapy-naïve) treatment for mCRPC between January 1, 2012, and December 31, 2017 in Ontario, Canada | 3405 | 78.9 (7.2 overall) | 3405 (100%) | Prostate | UTI, treatment-related toxicity | n/a |
| Xia and Wang, 2016 [74] | Other: China | Retrospective Observational Cohort Study | Patients aged ≥ 18 years; medical patients with a definite diagnosis of solid cancer according to pathological results obtained by surgical or micro-invasive biopsy; tumor metastasis assessed by radiography or exfoliative cytology; life expectancy evaluated by an oncologist as > 3 months; > 3 days in the ICU; and nonpregnant women | 141 | 63 (54–74) | 87 (61.7%) | All solid tumors | Respiratory failure, severe sepsis or septic shock, acute renal failure, acute heart failure | Vasopressors, mechanical ventilation, renal replacement therapy |
| Yaman et al., 2022 [75] | Other: Turkey | Prospective Observational Cohort Study | Patients 18 years or older, having hematological cancer, having laboratory TLS or clinical TLS, and receiving a single dose (7.5 mg) rasburicase | 82 | 64 (19–85) | 43 (52.4%) | All hematological malignancies | Tumor lysis syndrome (TLS) | Rasburicase administration |
| Yildirim and Tanriverdi, 2014 [76] | Other: Turkey | Retrospective Observational Cohort Study | Patients > 18 yrs of age with cancer treated or followed at the Department of Medical Oncology of our institution between August 2011 and September 2013 | 107 | 51 (11.0, group 1); 52 (13.0, group 2) | 41 (64%, group 1); 21 (49%, group 2) | All | Dyspnea, pain, deterioration in general health status, fever, hemorrhage, icterus, abdominal distention/ascites, neurological symptoms | Pain treatment (fentanyl vs. tramadol vs. morphine), discharged, died in the ED, hospitalized |
| Yilmaz et al., 2017 [77] | Other: Turkey | Randomized Clinical Trial | Adults 18 to 65 years of age presenting to the ED with lung cancer and dyspnea; presentation to the ED with the complaint of shortness of breath and, such as dyspnea on exertion, wheezing, and accessory muscle use; not requiring assisted ventilation, peak expiratory flow rate (PEFR) of < 250 | 91 | Mean (95%CI): 54.7 (51.8–57.7) | 46 (50.5%) | Lung | Dyspnea | Salbutamol and magnesium sulfate |
Abbreviations: ED Emergency Department, MLBO Malignant large-bowel obstruction, KAMC-HC King Abdullah Medical City Health Clusters, CAR Chimeric Antigen Receptor, ICU Intensive Care Unit, IV Intravenous, INF Intranasal Fentanyl, IVH Intravenous Hydromorphone, HSCT Hematopoietic Stem Cell Transplant, ICI Immune Checkpoint Inhibitors, ICD-9 International Classification of Diseases V9th Rev., GI Gastrointestinal, CRC Colorectal Cancer, VTE Venous Thromboembolism, HDT High-dose Therapy, ASCT Autologous Stem Cell Transplant, PE Pulmonary Embolism, DVT Deep Vein Thromboses, CAT Cancer-associated Venous Thrombosis, BTP Breakthrough Pain, APSCU Acute Palliative-Supportive Care Unit, ECG Electrocardiogram, CPR Cardiopulmonary Resuscitation, VRE Vancomycin-Resistant Enterococcus, BSI Blood Stream Infection, EOL End of Life, HM Hematemesis and Melena, CED Coverage with Evidence Development, NRS Numeric Rating Scale, UTI Urinary Tract Infection, TLS Tumor lysis Syndrome