[Lung cancer: Prognosis in intensive care depends mainly on the acute complication]

J Gorham; L Ameye; M Paesmans; T Berghmans; J-P Sculier; A-P Meert

doi:10.1016/j.rmr.2018.05.014

[Lung cancer: Prognosis in intensive care depends mainly on the acute complication]

Rev Mal Respir. 2019 Mar;36(3):333-341. doi: 10.1016/j.rmr.2018.05.014. Epub 2019 Mar 18.

[Article in French]

Authors

J Gorham¹, L Ameye², M Paesmans², T Berghmans³, J-P Sculier³, A-P Meert³

Affiliations

¹ Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique. Electronic address: [email protected].
² Data Centre, Institut Jules-Bordet, rue Héger-Bordet, 1000 Bruxelles, Belgique.
³ Service des soins intensifs et urgences oncologiques & oncologie thoracique, Institut Jules-Bordet, rue Héger Bordet, 1000 Bruxelles, Belgique.

PMID: 30898468
DOI: 10.1016/j.rmr.2018.05.014

Abstract

Introduction: It has been demonstrated in unselected populations of cancer patients that prognosis in intensive care is essentially dependent on the extent of the acute physiological disturbance caused by the complication precipitating the admission. By contrast, the prognosis after hospital discharge remains dependent on the characteristics of the underlying neoplasm. The aim of our study was to confirm whether this general finding was the case in a specific population of lung cancer patients, since there are no data on this patient group in the literature.

Patients and methods: We conducted a retrospective study including all patients with lung cancer admitted to our ICU between September 1, 2008 and December 31, 2013.

Results: During this period, 180 different patients with lung cancer were admitted into ICU. The simplified acute physiology score II (SAPS II) (OR 1.07 ; 95% CI 1.04-1.11), respiratory failure (OR 4.00; 95% CI 1.76-9.07) and the presence of therapeutic limitations were the 3 factors independently affecting hospital mortality in multivariate analysis. Considering only patients discharged alive from the hospital, the presence of metastases (HR 2.30; 95% CI 1.44-3.65) and limitations on therapy (HR 5,89; IC 95% 3,11-11,14) were the two statistically independent prognostic factors for overall survival.

Conclusion: In this population of lung cancer patients admitted into ICU, independent predictors of hospital mortality are determined by the physiological perturbations induced by the acute presenting complication. After recovery from this, prognosis is again determined by the characteristics of the underlying cancer.

Keywords: Admission; Cancer bronchique, Réanimation, Pronostic, Admission, Techniques de support vital; Intensive care; Life support techniques; Lung neoplasm; Prognosis.

MeSH terms

Acute Disease
Adenocarcinoma / complications*
Adenocarcinoma / diagnosis*
Adenocarcinoma / mortality
Adenocarcinoma / therapy
Adult
Aged
Aged, 80 and over
Critical Care* / statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units / statistics & numerical data
Lung Neoplasms / complications*
Lung Neoplasms / diagnosis*
Lung Neoplasms / mortality
Lung Neoplasms / therapy
Male
Middle Aged
Patient Admission / statistics & numerical data
Patient Discharge / statistics & numerical data
Prognosis
Respiratory Distress Syndrome / diagnosis*
Respiratory Distress Syndrome / etiology
Respiratory Distress Syndrome / mortality
Respiratory Distress Syndrome / therapy
Respiratory Insufficiency / diagnosis
Respiratory Insufficiency / mortality
Respiratory Insufficiency / therapy
Retrospective Studies
Severity of Illness Index