Decisions regarding whether advanced cancer patients should be admitted to the intensive care units (ICU) is based on a complex suite of considerations, including short and long term prognosis, quality of life, and options to treat cancer. We set to describe demographic, clinical, and survival data and to identify factors associated with short and long term mortality in critically ill advanced cancer patients with non-elective admissions to general ICUs.
Critically ill adult cancer patients non-electively admitted to the ICUs at the American University of Beirut Medical Center (AUBMC) between August 2015 and 2016 were included. Demographic, clinical, and laboratory data was prospectively collected from first day of ICU admission up to 30 days after discharge. This study was observational and clinical decisions were left to the ICU team and attending physician.
91 patients were enrolled between August 2015 and 2016, with 41 patients (46%) dying in the ICU, and 12 patients (13.5%) within 30-days post-discharge. 7 patients were lost to follow-up. Mean OS was 137 days, and median OS was 31 days since date of admission to the ICU. Most common reasons for ICU admission were sepsis (68.5%) and respiratory failure (19%). Cox regression showed direct admission from the ED (2.4 times more likely to die), those with uncontrolled malignancies (1.8 times), chemotherapy within the last 30 days prior to ICU admission (2.3 times), and development of multi-organ failure (MOF) (2.5 times) in the ICU are major predictors of poor prognosis.
Our study showed receiving chemotherapy within thirty days prior to admission as a predictor of poor outcome in univariate and multivariate analyses. This has not been reported in a study population of this kind before. Also, many studies state that developing MOF, whether in the ICU or prior to admission negative prognostic factor. Finally, our study found that direct admission from the ED is a negative prognostic factor, which has only been reported for hematological malignancies in other studies. Thus, there is a need for the development of proper admission criteria for this population.
Clinical trial identification
Legal entity responsible for the study
American Unviersity of Beirut Medical Center
All authors have declared no conflicts of interest.