Abstract
To identify factors predicting ICU mortality and post-ICU survival in critically ill cancer patients admitted to ICU, a retrospective study of 586 patients was performed. Primary site and clinical stage of cancer, anti-cancer treatments prior to ICU admission, cause of ICU admission, treatments in ICU, type and number of organ failures, development of sepsis, outcome in ICU, survival time after ICU discharge, cause of death, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were recorded. The impact of each variable on ICU mortality and post-ICU survival was studied by univariate and multivariate analysis. The analyses of predictors of post-ICU survival were conducted in each of six observation periods (1 month, 3 months, 6 months, 1 year, 3 years, and 5 years after ICU discharge) to assess the predictors in relation to time progress. ICU mortality was 30%. Independent predictors of ICU mortality were brain tumor “odds ratio (OR) 2.93, 95% confidence interval (95%CI) 1.30∼6.60”, neurological failure (OR 4.08, 95%CI 2.07∼8.05), APACHE II scores (each 5 points; OR 1.31, 95%CI 1.07∼1.60), number of organ failures (OR 2.75, 95%CI 1.95∼3.88), and sepsis (OR 3.00, 95%CI 1.57∼5.73). Independent predictors of post-ICU survival were clinical stage, respiratory failure, hepatic failure, renal failure, APACHE II scores, and lung cancer. Clinical stage was consistently an independent predictor of post-ICU survival in every observation periods, although critical illness-related variables influenced post-ICU survival within one year after ICU discharge and the variables as predictors changed in each observation period. We conclude that to treat critically ill cancer patients in ICU are to treat anti-cancer treatment-associated complications of the patients with advanced or treatment-resistant cancers.
