Urinary [TIMP-2]·[IGFBP7] greater than 0.3 (ng/ml)(2)/1,000 identifies patients at risk for imminent AKI. Clinical trial registered with www.clinicaltrials.gov (NCT 01573962).

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A B S T R A C T PurposeLung cancer is the leading cause of cancer-related mortality. Intensive care unit (ICU) use among patients with cancer is increasing, but data regarding ICU outcomes for patients with lung cancer are limited. Patients and MethodsWe used the Surveillance, Epidemiology, and End Results (SEER) -Medicare registry (1992 to 2007) to conduct a retrospective cohort study of patients with lung cancer who were admitted to an ICU for reasons other than surgical resection of their tumor. We used logistic and Cox regression to evaluate associations of patient characteristics and hospital mortality and 6-month mortality, respectively. We calculated adjusted associations for mechanical ventilation receipt with hospital and 6-month mortality. ResultsOf the 49,373 patients with lung cancer admitted to an ICU for reasons other than surgical resection, 76% of patients survived the hospitalization, and 35% of patients were alive 6 months after discharge. Receipt of mechanical ventilation was associated with increased hospital mortality (adjusted odds ratio, 6.95; 95% CI, 6.89 to 7.01; P Ͻ .001), and only 15% of these patients were alive 6 months after discharge. Of all ICU patients with lung cancer, the percentage of patients who survived 6 months from discharge was 36% for patients diagnosed in 1992 and 32% for patients diagnosed in 2005, whereas it was 16% and 11% for patients who received mechanical ventilation, respectively. ConclusionMost patients with lung cancer enrolled in Medicare who are admitted to an ICU die within 6 months of admission. To improve patient-centered care, these results should guide shared decision making between patients with lung cancer and their clinicians before an ICU admission.

Objectives To compare the extravascular lung water index (EVLWi) and other markers of disease severity in patients with acute lung injury (ALI) versus patients at risk to develop it and to determine their ability to predict progression to ALI in patients at risk. Design EVLWi, dead space fraction, PaO2/FiO2, and other markers of disease severity were measured prospectively in 29 patients daily for five days after admission to the ICU. Patients had ALI as defined by the American European Consensus Committee (AECC) criteria or had risk factors to develop it. Setting The intensive care units of an academic tertiary referral hospital. Measurements and Main Results The mean EVLWi on day one for patients who progressed to ALI was higher than for those that did not (15.5ml/kg ± 7.4 vs. 8.7ml/kg ± 2.3, p=.04. None of the other physiologic parameters tested discriminated progression to ALI – to include the mean physiologic dead space (0.61 ± 0.06 vs. 0.59 ± 0.10, p = .67), PaO2/FiO2 ratio (322 ± 35 vs. 267 ± 98, p = .15) and static lung compliance (30.9 ± 13.5 vs. 38.5 ± 11.7, p= .24). An EVLWi cutoff value on day 1 of 10ml/Kg had a 63% sensitivity; 88% spec; PPV 83%, NPV 70% to predict progression to ALI. There was no difference in EVLWi between those who progressed to ALI vs. those who had ALI. (14.3 ± 4.7 vs. 15.5 ± 7.4, p= .97). Conclusions Elevated EVLWi is a feature of early ALI and discriminates between those with ALI and those without. Furthermore, EVLWi predicts progression to ALI in patients with risk factors to develop it 2.6 ± 0.3 days before the patients meet AECC criteria for it. These 2.6 ± 0.3 days may then represent missed opportunity for therapeutic intervention and improved outcome.