Article Abstract

Risk factors and mortality of adults with lung cancer admitted to the intensive care unit

Authors: Chih-Cheng Lai, Chung-Han Ho, Chin-Ming Chen, Shyh-Ren Chiang, Chien-Ming Chao, Wei-Lun Liu, Jhi-Joung Wang, Ching-Chieh Yang, Kuo-Chen Cheng

Abstract

Background: This study aims to investigate lung cancer patients’ risk factors for: intensive care unit (ICU) admission, infectious complications and organ dysfunction in the ICU, and prognosis after ICU admission.
Methods: The records of all patients with lung-cancer catastrophic-illness cards admitted to the ICU between 2003 and 2012 were reviewed. The primary endpoint was 1-year mortality.
Results: We finally analyzed the records of index-date-, age-, and sex-matched ICU-admitted (ICU+) lung cancer patients (n=17,687) and ICU-non-admitted (ICU–) lung cancer patients (n=35,374). The overall 1-year mortality rate was significantly (P<0.0001) higher for ICU+ patients (49.91%) than for ICU– patients (44.86%). Most ICU+ patients (56.16%) had infectious complications and organ dysfunction (52.33%), and overall, 6,893 (38.97%) had sepsis. Independent mortality risk factors were age (≥75 years) [adjusted hazard ratio (AHR), 1.22; 95% confidence interval (CI), 1.16–1.29], male sex: (AHR, 1.18; 95% CI, 1.13–1.23), recent radiotherapy (AHR, 1.09; 95% CI, 1.04–1.15), infectious complications (AHR: 1.23; 95% CI: 1.17–1.29), organ dysfunction (AHR, 1.57; 95% CI, 1.50–1.65), and hospital level (regional hospital: AHR, 1.11; 95% CI, 1.06–1.16; local hospital: AHR, 1.28; 95% CI, 1.18–1.37).
Conclusions: ICU admission for lung cancer patients is associated with higher mortality. Several risk factors of mortality for ICU+ patients should help physicians provide patients personalized and better-informed lung cancer therapy decisions.