Factors associated with short-term and long-term mortality in solid cancer patients admitted to the ICU

Introduction

Despite multiple reports demonstrating an improvement in outcomes of critically ill cancer patients admitted to ICUs over the last two decades [1], there is concern that admission policies for patients with cancer are overly restrictive [2]. The purpose of this study was to identify factors associated with mortality in the 180 days following unplanned ICU admission in patients with nonhaematological malignancy.

Methods

We carried out a retrospective analysis of all patients with solid tumours admitted to the Guy's Critical Care Unit (13-bed level 3 ICU) as an emergency between August 2008 and July 2012. Data were collected regarding patient demographics, type of cancer, reason for referral and organ support required during the ICU stay.

Results

During the 4-year study period there were 356 unplanned admissions of patients with solid cancer (8.3% of all admissions). Three hundred individual patients were admitted and 180-day survival data were available for 293 of these. Mean age at first admission was 65.2 years, 115 (38.3%) were female. The most frequently present malignancies were lung (42.7%), head and neck (17.3%) and renal (6.7%). ICU, hospital and 180-day mortality were 19.1%, 31.0% and 52.2% respectively. Those factors found to be independently associated (in multivariate analysis) with increased risk of 180-day mortality include: metastases (OR = 4.0, 95% CI = 2.1 to 7.6); sepsis on admission (OR = 2.2, 95% CI = 1.2 to 4.1); APACHE II score on admission (OR = 1.06, 95% CI = 1.004 to 1.12); need for inotropes/vasopressors during admission (OR = 2.3, 95% CI = 1.05 to 4.8); and need for renal replacement therapy during admission (OR = 4.65, 1.7 to 12.8).

Conclusion

In our study, ICU and hospital mortality were lower than the pooled mortalities seen in a recent large systematic review [3] - despite our study excluding planned postoperative admissions (who are known to have better outcomes). The 180-day mortality was significantly lower than in a previous study at our own institution [4]. Our study looked at a number of factors that might reasonably be expected to be associated with short-term and long-term outcomes and identified several that were independent predictors of death by 180 days.