Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, Texas, USA
J Investig Med. 2022 Mar;70(3):820-828. doi: 10.1136/jim-2021-002032. Epub 2021 Sep 17.
The appropriateness of intensive care unit (ICU) admission of patients with metastatic cancer remains debated. We aimed to examine the short-term outcomes and their temporal pattern in critically ill patients with metastatic disease. We used state-wide data to identify hospitalizations aged ≥18 years with metastatic cancer admitted to ICU in Texas during 2010-2014. Multivariable logistic regression modeling was used to examine the factors associated with short-term mortality and its temporal trends among all ICU admissions and those undergoing mechanical ventilation. Among 136,644 ICU admissions with metastatic cancer, 50.8% were aged ≥65 years, with one or more organ failures present in 53.3% and mechanical ventilation was used in 11.1%. The crude short-term mortality among all ICU admissions and those mechanically ventilated was 28.1% and 62.0%, respectively. Discharge to home occurred in 57.1% of all ICU admissions. On adjusted analyses, short-term mortality increased with rising number of organ failures (adjusted OR (aOR) 1.399, 95% CI 1.374 to 1.425), while being lower with chemotherapy (aOR 0.467, 95% CI 0.432 to 0.506) and radiation therapy (aOR 0.832, 95% CI 0.749 to 0.924), and decreased over time (aOR 0.934 per year, 95% CI 0.924 to 0.945). Predictors of short-term mortality were largely similar among those undergoing mechanical ventilation. Most ICU admissions with metastatic cancer survived hospitalization, although short-term mortality was very high among those undergoing mechanical ventilation. Short-term mortality decreased over time and was lower among those receiving chemotherapy and radiation therapy. These findings support consideration of critical care in patients with metastatic cancer, but underscore the need to address patient-centered goals of care ahead of ICU admission.
接受重症监护的转移性癌症患者的适宜性仍存在争议。我们旨在研究危重病患者转移性疾病的短期预后及其时间模式。我们使用全州数据，确定了 2010 年至 2014 年期间在德克萨斯州入住 ICU 的年龄≥18 岁的转移性癌症住院患者。使用多变量逻辑回归模型，研究了所有 ICU 入院患者和接受机械通气患者短期死亡率的相关因素及其时间趋势。在 136644 例患有转移性癌症的 ICU 入院患者中，50.8%的患者年龄≥65 岁，53.3%的患者存在一个或多个器官衰竭，11.1%的患者使用了机械通气。所有 ICU 入院患者和接受机械通气的患者的短期死亡率分别为 28.1%和 62.0%。所有 ICU 入院患者中，有 57.1%出院回家。在调整后的分析中，短期死亡率随着器官衰竭数量的增加而增加（调整后的比值比（aOR）1.399，95%可信区间（CI）为 1.374 至 1.425），而化疗（aOR 0.467，95%CI 为 0.432 至 0.506）和放疗（aOR 0.832，95%CI 为 0.749 至 0.924）则降低，且随时间呈下降趋势（每年降低 0.934，95%CI 为 0.924 至 0.945）。机械通气患者的短期死亡率预测因素基本相似。大多数患有转移性癌症的 ICU 入院患者存活出院，但接受机械通气的患者短期死亡率非常高。短期死亡率随时间降低，且接受化疗和放疗的患者死亡率较低。这些发现支持在转移性癌症患者中考虑重症监护，但强调在 ICU 入院前需要解决以患者为中心的护理目标。
