European Journal of Respiration. 2007 Aug 22; [Epub ahead of print] [Link]
Adam AK, Soubani AO.
Allergy, Critical Care and Sleep Medicine.
To assess the outcome of lung cancer patients who were admitted to a medical ICU (MICU), and to identify the measurable predictors of their MICU outcome.
MICUs of a university affiliated medical center
Adult lung cancer patients admitted to the MICU between January 1998 and October 2005.
139 lung cancer patients included during the study period. The mean age (+/-SD) at MICU admission was 64.2 +/- 10.2years (men 48%, women 52%). 96 patients (69%) had non-small cell lung cancer, 18 patients (13%) 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 patietns). Sixty eight patients (49%) 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, APACHE III and SAPS III scores, the use of vasopressors, positive blood cultures, high serum lactate, two or more organ system failure, the need for ACLS. On multivariate analysis only the need for vasopressors and the presence of two or more organ systems failure predicted poor MICU outcome.
The study shows that the MICU outcome of lung cancer patients is better than previously reported. Intensive care and MV 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 systems failure predicted poor MICU.
Keywords: Lung cancer, medical ICU, mechanical ventilation, multiorgan system failure, outcome, prognosis