Abstract
PurposeIntensive care unit (ICU)-related mortality for lung cancer is ranked highest among the solid tumors and little information exists on the role of intensivists on clinical outcomes. This study aimed to elucidate the intensivist’s contribution toward clinical outcomes.Materials and methodsData of advanced lung cancer patients, including stage IIIB or IV non-small cell lung cancer and extensive-stage small cell lung cancer, admitted to the ICU from 2005 to 2016 were analyzed. Multivariate logistic regression was performed to determine variables associated with ICU and in-hospital mortality. Autoregressive integrated moving average (ARIMA) for time-series was used to assess the intensivist’s impact.ResultsOf 264 patients, 85 (32.2%) were admitted to the ICU before and 179 (67.8%) after organized intensive care introduction in 2011. Before and after 2011, the changes observed were as follows: ICU mortality rate, 43.5% to 40.2%, respectively (p = 0.610); hospital mortality rate, 82.4% to 65. 9% (p = 0.006). The duration of ICU and hospital stay decreased after 2011 (14.5±16.5 vs. 8.3 ± 8.6, p < 0.001; 36.6 ± 37.2 vs. 22.0 ± 19.6, p < 0.001). On multivariate analysis, admission after 2011 was independently associated with decreased hospital mortality (Odds ratio 0.42, 95% confidence interval 0.21–0.77, p = 0.006). In ARIMA models, intensivist involvement was associated with significantly reduced hospital mortality. (Estimate -17.95, standard error 5.31, p = 0.001)ConclusionIn patients with advanced lung cancer, organized intensive care could contribute to improved clinical outcomes.
Highlights
Lung cancer is the leading cause of cancer death in South Korea [1] and worldwide [2]
Before and after 2011, the changes observed were as follows: Intensive care unit (ICU) mortality rate, 43.5% to 40.2%, respectively (p = 0.610); hospital mortality rate, 82.4% to 65. 9% (p = 0.006)
In Autoregressive integrated moving average (ARIMA) models, intensivist involvement was associated with significantly reduced hospital mortality. (Estimate -17.95, standard error 5.31, p = 0.001)
Summary
Lung cancer is the leading cause of cancer death in South Korea [1] and worldwide [2]. It is the most common cause of intensive care unit (ICU) admission among solid tumors, and the number of admissions has increased over time in the United States [3, 4]. Patients with lung cancer often require intensive care due to the aggressive nature of the disease. Survival in critically ill patients with cancer has improved over the decades [6, 7], ICU mortality related to lung cancer is ranked highest among the solid tumors [8]. In a multinational study published in 2014, which included a high percentage of newly-diagnosed patients (71%), lung cancer patients had a high rate of ICU mortality (29%) [9]
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