title: Prognosis of lung cancer patients with life-threatening complications.
abstract: BACKGROUND
  The management of patients with lung cancer has improved recently, and many of them will require admission to the ICU. The aims of this study were to determine hospital mortality and to identify risk factors for death in a large cohort of critically ill patients.
  
  
  METHODS
  Cohort study in two ICUs specialized in the management of patients with cancer, in France and Brazil.
  
  
  RESULTS
  Of the 143 patients (mean age, 61.6 +/- 9.9 years [+/- SD]), 25 patients (17%) had small cell lung cancer and 118 patients (83%) had non-small cell lung cancer. The main reasons for ICU admission were sepsis (44%) and acute respiratory failure (31%). Mechanical ventilation (MV) was used in 100 patients (70%), including 38 patients in whom lung cancer was considered a reason for MV. Hospital mortality was 59% overall and 69% in patients receiving MV. By multivariate logistic regression, airway infiltration or obstruction by cancer, number of organ failures, cancer recurrence or progression, and severity of comorbidities were associated with increased mortality.
  
  
  CONCLUSIONS
  The improved survival previously reported in patients with cancer admitted to the ICU seems to extend to patients with lung cancer, including those who need MV. Mortality increased with the number of organ failures, severity of comorbidities, and presence of respiratory failure due to cancer progression. The type of the cancer per se was not associated with mortality and, therefore, should not be factored into ICU triage decisions.
authors.affiliation: Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil. Electronic address: marciosoaresms@yahoo.com.br.
authors.forename: Márcio
authors.initials: M
authors.lastname: Soares
authors.affiliation: Service de Reanimation Medicale, Hopital Saint-Louis et Universite Paris 7, Assistance Publique, Hôpitaux de Paris, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.affiliation: Intensive Care Unit, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Jorge I F
authors.initials: JIF
authors.lastname: Salluh
authors.affiliation: Department of Clinical Research, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Ferreira
authors.affiliation: Service de Reanimation Medicale, Hopital Saint-Louis et Universite Paris 7, Assistance Publique, Hôpitaux de Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Thiéry
authors.affiliation: Service de Reanimation Medicale, Hopital Saint-Louis et Universite Paris 7, Assistance Publique, Hôpitaux de Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Schlemmer
authors.affiliation: Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Nelson
authors.initials: N
authors.lastname: Spector
authors.affiliation: Service de Reanimation Medicale, Hopital Saint-Louis et Universite Paris 7, Assistance Publique, Hôpitaux de Paris, France.
authors.forename: Élie
authors.initials: É
authors.lastname: Azoulay
mesh_terms: D000368:Aged; D001938:Brazil; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications* / Q000401:mortality*; D018288:Carcinoma, Small Cell / Q000150:complications* / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012121:Respiration, Artificial / Q000401:mortality; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis