Six-month prognosis of patients with lung cancer admitted to the intensive care unit.
BACKGROUND
Intensive care unit (ICU) admission of patients with lung cancer remains debated because of the poor short-term prognosis. However, ICU admission of such patients should also be assessed on the possibility to administer specific anticancer treatment and the long-term outcome thereafter.


OBJECTIVE
To identify predictive factors of hospital and 6-month mortality in critically ill lung-cancer patients.


METHODS
Retrospective study conducted in the ICU of a university hospital.


METHODS
One hundred five consecutive lung-cancer patients included between 1 January 1997 and 31 December 2006.


METHODS
None.


RESULTS
Of the 105 patients (mean age 64.8 years), 87 (83%) had a non-small cell lung cancer (NSCLC). Extensive disease was diagnosed in 85 patients (83%) (NSCLC stages IIIB and IV or disseminated small cell lung cancer). The main reasons for ICU admission were acute respiratory failure (59%) and/or hemoptysis (45%). Forty-three patients (41%) needed mechanical ventilation (MV). The ICU, hospital and 6-month mortality rates were 43, 54 and 73%, respectively. A performance status (PS) >or=2 [odds ratio OR = 3.6 (95% confidence interval CI (1.5-8.7)] and acute respiratory failure [OR = 3.5 (95% CI (1.5-8.4)] predicted hospital mortality. In a multivariate Cox model, the cancer progression [hazard ratio HR = 6.1 (95% CI 2.2-17)] and the need for MV [HR = 3.6 (95% CI 1.35-9.4)] were independently associated with 6-month mortality. Two-thirds of the ICU survivors were able to receive anticancer treatment.


CONCLUSIONS
ICU admission should be considered in selected patients with lung cancer (PS <2, no cancer disease progression).
Roques
Sébastien
S
Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020 Paris, France. broques1@yahoo.com
Parrot
Antoine
A
Lavole
Armelle
A
Ancel
Pierre-Yves
PY
Gounant
Valérie
V
Djibre
Michel
M
Fartoukh
Muriel
M
D000208:Acute Disease; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000401:mortality* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010343:Patient Admission / Q000706:statistics & numerical data*; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000534:rehabilitation; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors