title: Six-month prognosis of patients with lung cancer admitted to the intensive care unit.
abstract: 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).
authors.affiliation: Service de Pneumologie et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 75020 Paris, France. broques1@yahoo.com
authors.forename: Sébastien
authors.initials: S
authors.lastname: Roques
authors.forename: Antoine
authors.initials: A
authors.lastname: Parrot
authors.forename: Armelle
authors.initials: A
authors.lastname: Lavole
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Ancel
authors.forename: Valérie
authors.initials: V
authors.lastname: Gounant
authors.forename: Michel
authors.initials: M
authors.lastname: Djibre
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
mesh_terms: 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