Outcome and prognostic factors of lung cancer patients admitted to the medical intensive care unit

Abstract

The aim of the present study was to assess the outcome of lung cancer patients who were admitted to a medical intensive care unit (MICU) and to identify the measurable predictors of their MICU outcome.The retrospective study took place at the MICUs of a university-affiliated medical centre and involved adult lung cancer patients admitted to the MICU between January 1998 and October 2005.A total of 139 lung cancer patients were included during the study period. The mean age¡SD at MICU admission was 64.2¡10.2 yrs (48% males, 52% females). In total, 96 (69%) patients had nonsmall cell lung cancer, 18 (13%) patients had small cell lung cancer, and one patient had mesothelioma. The MICU mortality was 22% (31 patients), while the in-hospital mortality was 40% (56 patients). Sixty-eight (49%) patients required mechanical ventilation (MV), with MICU mortality of 38% and in-hospital mortality of 53%. The independent predictors of poor MICU outcome were: the need for MV; Acute Physiology And Chronic Health Evaluation III and Simplified Acute Physiology Score III scores; the use of vasopressors; positive blood cultures; high serum lactate; two or more organ system failures; and the need for adult cardiac life support. On multivariate analysis, only the need for vasopressors and the presence of two or more organ system failures predicted poor MICU outcome.The present study shows that the medical intensive care unit outcome of lung cancer patients is better than previously reported. Intensive care and mechanical ventilation should not be considered futile care in this patient population. While there were no absolute predictors of mortality, the need for vasopressors and the presence of two or more organ system failures predicted poor medical intensive care unit care.

Critical care management of lung cancer patients to prolong life without prolonging dying

“…In this valuable contribution to the existing literature, the encouraging short-and medium-term survival rates corroborate the results of other recent studies [10,11]. One of the most interesting aspects of the study by Dr. Roques et al [18] is the 6-month evaluation of ICU survivors.…”

“…Survival gains were demonstrated in patients with a variety of characteristics including neutropenia [4], severe sepsis [5,6], acute kidney injury [7], prolonged ICU admission [8] and recent chemotherapy [9], as well as in specific subgroups of patients believed to have very low chances of survival, such as patients with lung cancer [10,11]. These studies highlighted not only the beneficial impact of advances in critical care and in hematology and oncology, but also the inadequacy of our triage criteria [12].…”

Outcome in critically ill patients with allogeneic BM or peripheral haematopoietic SCT: a single-centre experience

“…Table 1 Principal admission diagnosis in ABMT/AHSCT patients (n ¼ 44) The outcome of allogeneic BM transplant patients with acute critical illness is described P Depuydt et al Short-term outcome in critically ill patients with solid cancer or haematological malignancy has been shown to be mainly predicted by the number of failing organs, rather than by the underlying neoplasy characteristics. 8,9,[23][24][25] Acute respiratory failure (ARF) with need for MV is the most common reason for ICU referral in these patients and is a very strong predictor for poor outcome. Moreover, whereas prognosis for mechanically ventilated cancer patients (including haematological patients) in general has improved over the last two decades, this trend has not been observed in ABMT/AHSCT patients, in whom ICU and inhospital mortality rates have not reduced below 80%.…”

Clinical Characteristics and Prognosis of Lung Cancer Patients Admitted to the Medical Intensive Care Unit at a University Hospital

“…최근 폐암은 암 관련 사망의 주된 원인이 되었다 1,2 . 폐 암 환자의 5년 생존율은 평균 15% 정도이며 수술이 불가 능한 폐암 환자의 5년 생존율은 5%에도 미치지 못하 고 있다 3,4 .…”