Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit

Objective: To assess survival in cancer patients admitted to an intensive c are unit (ICU) with respect to the nature of malignancy, cause of ICU admit tance, and course during ICU stay as well as to evaluate the prognostic val ue of the Acute Physiology and Chronic Health Evaluation (APACHE) III score . Design: Retrospective cohort study. Setting: ICU at a university cancer ref erral center. Patients: A total of 414 cancer patients admitted to the ICU during a perio d of 66 months. Interventions: None. Measurements: Charts of the patients were analyzed with respect to underlyi ng disease, cause of admission, APACHE III score, need and duration of mech anical ventilation, neutropenia and development of septic shock, as well as ICU survival and survival after discharge. Mortality data were compared wi th two control groups: 1362 patients admitted to our ICU suffering from dis eases other than cancer and 2,776 cancer patients not admitted to the ICU. Main Results: ICU survival was 53%, and 1-yr survival was 23%. The 1-yr mor tality rate was significantly lower in both control groups. Patients admitt ed after bone marrow transplantation had the highest mortality. In a multiv ariate analysis, prognosis was negatively influenced by respiratory insuffi ciency, 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 af ter surgery and as a result of acute hemorrhage was associated with a good prognosis. Age, neutropenia, and underlying disease did not influence outco me significantly. Admission APACHE III scores were significantly higher in nonsurvivors but failed to predict individual outcome satisfactorily. All p atients with APACHE III scores of >80 died at the ICU. Conclusion: A combination of factors must be taken into account to estimate a critically ill cancer patient's prognosis in the ICU. The APACHE III sco ring system alone should not be used to make decisions about therapy prolon gation. Admission to the ICU worsens the prognosis of a cancer patient subs tantially; however, as ICU mortality is 47%, comparable with severely ill n oncancer patients, general reluctance to admit cancer patients to an ICU do es not seem to be justified.