title: Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit.
abstract: OBJECTIVE
  To assess survival in cancer patients admitted to an intensive care unit (ICU) with respect to the nature of malignancy, cause of ICU admittance, and course during ICU stay as well as to evaluate the prognostic value of the Acute Physiology and Chronic Health Evaluation (APACHE) III score.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  ICU at a university cancer referral center.
  
  
  METHODS
  A total of 414 cancer patients admitted to the ICU during a period of 66 months.
  
  
  METHODS
  None.
  
  
  METHODS
  Charts of the patients were analyzed with respect to underlying disease, cause of admission, APACHE III score, need and duration of mechanical ventilation, neutropenia and development of septic shock, as well as ICU survival and survival after discharge. Mortality data were compared with two control groups: 1362 patients admitted to our ICU suffering from diseases other than cancer and 2,776 cancer patients not admitted to the ICU.
  
  
  RESULTS
  ICU survival was 53%, and 1-yr survival was 23%. The 1-yr mortality rate was significantly lower in both control groups. Patients admitted after bone marrow transplantation had the highest mortality. In a multivariate analysis, prognosis was negatively influenced by respiratory insufficiency, the need of mechanical ventilation, and development of septic shock during the ICU stay. Admission after cardiopulmonary resuscitation yielded high ICU mortality but a relatively good long-term prognosis. Admission after surgery and as a result of acute hemorrhage was associated with a good prognosis. Age, neutropenia, and underlying disease did not influence outcome significantly. Admission APACHE III scores were significantly higher in nonsurvivors but failed to predict individual outcome satisfactorily. All patients with APACHE III scores of >80 died at the ICU.
  
  
  CONCLUSIONS
  A combination of factors must be taken into account to estimate a critically ill cancer patient's prognosis in the ICU. The APACHE III scoring system alone should not be used to make decisions about therapy prolongation. Admission to the ICU worsens the prognosis of a cancer patient substantially; however, as ICU mortality is 47%, comparable with severely ill noncancer patients, general reluctance to admit cancer patients to an ICU does not seem to be justified.
authors.affiliation: Department of Internal Medicine I, University of Vienna, Austria. thomas.staudinger@akh-wien.ac.at
authors.forename: T
authors.initials: T
authors.lastname: Staudinger
authors.forename: B
authors.initials: B
authors.lastname: Stoiser
authors.forename: M
authors.initials: M
authors.lastname: Müllner
authors.forename: G J
authors.initials: GJ
authors.lastname: Locker
authors.forename: K
authors.initials: K
authors.lastname: Laczika
authors.forename: S
authors.initials: S
authors.lastname: Knapp
authors.forename: H
authors.initials: H
authors.lastname: Burgmann
authors.forename: A
authors.initials: A
authors.lastname: Wilfing
authors.forename: J
authors.initials: J
authors.lastname: Kofler
authors.forename: F
authors.initials: F
authors.lastname: Thalhammer
authors.forename: M
authors.initials: M
authors.lastname: Frass
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis