Abstract
BackgroundThe objective of this study was to identify risk factors predicting prognosis of critically ill medical patients with advanced solid tumors in the intensive care unit (ICU).MethodsWe retrospectively analyzed all ICU unplanned medical admissions to the ICU of patients with advanced solid cancer in Tianjin Medical University Cancer Institute and Hospital between October 1, 2012 and March 1, 2015. Approval was obtained from the Ethical Commission of Tianjin Medical University Cancer Institute and Hospital to review and publish information from patients’ records.ResultsOne hundred and forty-one patients with full code status met the criteria for inclusion from among 813 ICU admissions. ICU mortality was 14.9 % and in-hospital mortality was 29.8 %. The major reasons for unplanned ICU admission were respiratory failure (38.3 %) and severe sepsis or septic shock (27.7 %). The ICU mortality in patients who required vasopressors, mechanical ventilation or renal replacement therapy for >24 h was 25, 25.9 and 40 %, respectively. The mean overall survival was 28.6 months. After adjusting for hypertension, type of solid cancer, intervention time, need for mechanical ventilation and Acute Physiology and Chronic Health Evaluation II score, only Sepsis-related Organ Failure Assessment (SOFA) score on day 7 of ICU treatment remained a significant predictor of ICU mortality (adjusted odds ratio 1.612, 95 % confidence interval 1.137–2.285, P = 0.007).ConclusionsWe suggest broadening the criteria for ICU admission. The patients should be allowed an ICU trial consisting of unlimited ICU support, including invasive hemodynamic monitoring, mechanical ventilation and renal replacement therapy. An interdisciplinary meeting, including an ethics consultation, should be held to make end-of-life decisions if the SOFA score on day 7 shows clinical deterioration with no available therapeutic options.
Highlights
The objective of this study was to identify risk factors predicting prognosis of critically ill medical patients with advanced solid tumors in the intensive care unit (ICU)
Cancer treatment near the end-of-life has become more aggressive and intensive care unit (ICU) mortality of cancer patients has improved in recent years [7,8,9,10,11,12,13]
Patients who met all the following criteria were included: adult patients aged ≥18 years; medical patients with a definite diagnosis of solid cancer according to pathological results obtained by surgical or microinvasive biopsy; tumor metastasis assessed by radiography or exfoliative cytology; life expectancy evaluated by an oncologist as >3 months; >3 days in the ICU; and nonpregnant women
Summary
The objective of this study was to identify risk factors predicting prognosis of critically ill medical patients with advanced solid tumors in the intensive care unit (ICU). As a Cancer treatment near the end-of-life has become more aggressive and intensive care unit (ICU) mortality of cancer patients has improved in recent years [7,8,9,10,11,12,13]. Patients with hematological or advanced-stage solid malignancies are still frequently denied admission to ICUs according to current policies, even if some of them may survive. There have been few studies about unplanned ICU admission of critically ill patients with advanced solid tumors in China; we conducted this study
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