Anisoglou S, Asteriou C, Barbetakis N, Kakolyris S, Anastasiadou G, Pnevmatikos I
Intensive Care Unit, Theagenio Cancer Hospital, Thessaloniki, Greece.
Hippokratia. 2013 Jan;17(1):60-3.
Previous studies have shown that the outcome of lung cancer patients who were admitted to the Intensive Care Unit (ICU), especially those requiring mechanical ventilation, is extremely poor. The present study was conducted in order to assess the outcome of a recent cohort of lung cancer patients admitted to the ICU with acute respiratory failure.
A retrospective analysis of the medical records of 105 lung cancer patients who were admitted to the ICU between January 2008 and January 2011 was performed. Severity of illness on the first day of ICU admission was assessed using the acute physiology and chronic health evaluation (APACHE) II and the sequential organ failure assessment (SOFA) scoring systems. Associated organ failure was determined according to the Knaus criteria.
Eighty four (80%) patients were diagnosed with non-small cell lung cancer, 14 (13.3%) with small cell lung cancer, one patient with mesothelioma, and in the remaining 6 patients, the type of lung cancer could not be determined. Significant factors on admission were APACHE II and SOFA scores, poor performance status and severe comorbidity. During ICU stay, the main risk factors for poor outcome were the long term mechanical ventilation duration, use of vasopressors, more than two organ system failures and septic condition. The overall ICU, hospital and 6-month mortality rates were 44.7% (47/105), 56.1% (59/105) and 77.1% (81/105) respectively.
The present data show that the medical intensive care unit outcome of lung cancer patients is improving. Further studies of patients selected to ICU admission are needed to assess long-term mortality, quality of life, ability to continue chemotherapy and economic cost.
既往研究表明，入住重症监护病房（ICU）的肺癌患者，尤其是那些需要机械通气的患者，预后极差。本研究旨在评估近期因急性呼吸衰竭入住ICU的一组肺癌患者的预后。
对2008年1月至2011年1月期间入住ICU的105例肺癌患者的病历进行回顾性分析。使用急性生理与慢性健康状况评估（APACHE）II和序贯器官衰竭评估（SOFA）评分系统评估ICU入院第一天的病情严重程度。根据克瑙斯标准确定相关器官衰竭情况。
84例（80%）患者被诊断为非小细胞肺癌，14例（13.3%）为小细胞肺癌，1例为间皮瘤，其余6例患者肺癌类型无法确定。入院时的显著因素为APACHE II和SOFA评分、较差的体能状态和严重的合并症。在ICU住院期间，预后不良的主要危险因素为长期机械通气时间、使用血管升压药、两个以上器官系统衰竭和脓毒症状态。ICU总体死亡率、医院死亡率和6个月死亡率分别为44.7%（47/105）、56.1%（59/105）和77.1%（81/105）。
目前的数据表明，肺癌患者的医疗重症监护病房预后正在改善。需要对入选入住ICU的患者进行进一步研究，以评估长期死亡率、生活质量、继续化疗的能力和经济成本。
