Short-term and medium-term survival of critically ill patients with solid tumours admitted to the intensive care unit: a retrospective analysis

Abstract

ObjectivesPatients with cancer frequently require unplanned admission to the intensive care unit (ICU). Our objectives were to assess hospital and 180-day mortality in patients with a non-haematological malignancy and unplanned ICU admission and to identify which factors present on admission were the best predictors of mortality.DesignRetrospective review of all patients with a diagnosis of solid tumours following unplanned admission to the ICU between 1 August 2008 and 31 July 2012.SettingSingle centre tertiary care hospital in London (UK).Participants300 adult patients with non-haematological solid tumours requiring unplanned admission to the ICU.InterventionsNone.Primary and secondary outcomesHospital and 180-day survival.Results300 patients were admitted to the ICU (median age 66.5 years; 61.7% men). Survival to hospital discharge and 180 days were 69% and 47.8%, respectively. Greater number of failed organ systems on admission was associated with significantly worse hospital survival (p<0.001) but not with 180-day survival (p=0.24). In multivariate analysis, predictors of hospital mortality were the presence of metastases (OR 1.97, 95% CI 1.08 to 3.59), Acute Physiology and Chronic Health Evaluation II (APACHE II) Score (OR 1.07, 95% CI 1.01 to 1.13) and a Glasgow Coma Scale Score <7 on admission to ICU (OR 5.21, 95% CI 1.65 to 16.43). Predictors of worse 180-day survival were the presence of metastases (OR 2.82, 95% CI 1.57 to 5.06), APACHE II Score (OR 1.07, 95% CI 1.01 to 1.13) and sepsis (OR 1.92, 95% CI 1.09 to 3.38).ConclusionsShort-term and medium-term survival in patients with solid tumours admitted to ICU is better than previously reported, suggesting that the presence of cancer alone should not be a barrier to ICU admission.

Factors predicting short-term and long-term mortality in ICU patients with a malignancy: the importance of SOFA and ECOG performance status

“…Similar to our study, severity of illness (measured by the SOFA score) has been described in literature as predictor for short-term mortality in patients with a malignancy (30,31,41) and long-term mortality (38,39,42). Studies which describe SOFA score and performance status as long-term predictor have maximal 1 year of follow up after ICU admission.…”

Performance of Three Prognostic Models in Critically Ill Patients with Cancer: A Prospective Study

“…invasive mechanical ventilation) [19,20], and comprises two cancer-specific variables (e.g. clinical stage of cancer and non-malignancy-related admission) related with mortality in cancer patients admitted to ICU [10,21]. Thus, it is not surprising a better fitting and discrimination with APACHE-II CCP model than those observed with general predictive models.…”

Challenging decision: ICU admission of critically ill elderly solid tumor patients

“…Studies of critically ill cancer patients admitted to the ICU have revealed that age alone was not a predictor of mortality (10)(11)(12)(13)(14). Severity of clinical condition as assessed by SAPS 2, Sequential Organ Failure Assessment (SOFA), Acute Physiology, Chronic Health Evaluation II (APACHE) or similar methods at ICU admission was of utmost importance rather than age.…”

“…Severity of clinical condition as assessed by SAPS 2, Sequential Organ Failure Assessment (SOFA), Acute Physiology, Chronic Health Evaluation II (APACHE) or similar methods at ICU admission was of utmost importance rather than age. Uncontrolled or metastatic disease (11-13), sepsis or septic shock (11,12), organ dysfunction (11,12), performance status (12,13), use of mechanical ventilation (12)(13)(14), and type of solid tumor (14) were other factors associated with hospital mortality.…”