Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan.
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, 155, Section 2, Linong Street, Taipei, 112, Taiwan.
BMC Pulm Med. 2022 Jun 24;22(1):245. doi: 10.1186/s12890-022-02042-7.
The survival of patients with lung cancer undergoing critical care has improved. An increasing number of patients with lung cancer have signed a predefined do-not-intubate (DNI) order before admission to the intensive care unit (ICU). These patients may still be transferred to the ICU and even receive non-invasive ventilation (NIV) support. However, there is still a lack of prognostic predictions in this cohort. Whether patients will benefit from ICU care remains unclear.
We retrospectively collected data from patients with advanced lung cancer who had signed a DNI order before ICU admission in a tertiary medical center between 2014 and 2016. The clinical characteristics and survival outcomes were discussed.
A total of 140 patients (median age, 73 years; 62.1% were male) were included, had been diagnosed with stage III or IV non-small cell lung cancer (NSCLC) (AJCC 7th edition), and signed a DNI. Most patients received NIV during ICU stay. The median APACHE II score was 14 (standard error [SE], ± 0.66) and the mean PaO2/FiO2 ratio (P/F ratio) was 174.2 (SD, ± 104 mmHg). The APACHE II score was significantly lower in 28-day survivors (survivor: 12 (± 0.98) vs. non-survivor: 15 (± 0.83); p = 0.019). The P/F ratio of the survivors was higher than that of non-survivors (survivors: 209.6 ± 111.4 vs. non-survivors: 157.9 ± 96.7; p = 0.006). Patients with a P/F ratio ≥ 150 had better 28-day survival (p = 0.005). By combining P/F ratio ≥ 150 and APACHE II score < 16, those with high P/F ratios and low APACHE II scores during ICU admission had a notable 28-day survival compared with the rest (p < 0.001). These prognostic factors could also be applied to 90-day survival (p = 0.003). The prediction model was significant for those with driver mutations in 90-day survival (p = 0.021).
P/F ratio ≥ 150 and APACHE II score < 16 were significant prognostic factors for critically ill patients with lung cancer and DNI. This prediction could be applied to 90-day survival in patients with driver mutations. These findings are informative for clinical practice and decision-making.
接受重症监护的肺癌患者的生存率有所提高。越来越多的肺癌患者在入住重症监护病房（ICU）前签署了预先设定的不插管（DNI）医嘱。这些患者仍可能被转至 ICU 并接受无创通气（NIV）支持。然而，在这一人群中仍然缺乏预后预测。患者是否能从 ICU 治疗中获益仍不清楚。
我们回顾性收集了 2014 年至 2016 年间在一家三级医疗机构 ICU 入住前签署 DNI 医嘱的晚期肺癌患者的数据。讨论了临床特征和生存结局。
共纳入 140 例患者（中位年龄 73 岁；62.1%为男性），诊断为 III 或 IV 期非小细胞肺癌（NSCLC）（AJCC 第 7 版），并签署了 DNI。大多数患者在 ICU 期间接受了 NIV。中位急性生理学与慢性健康状况评分系统 II（APACHE II）评分为 14（标准误差 [SE]，±0.66），平均氧分压/吸入氧分数比值（P/F 比值）为 174.2（SD，±104mmHg）。28 天存活者的 APACHE II 评分明显低于非存活者（存活者：12（±0.98） vs. 非存活者：15（±0.83）；p=0.019）。存活者的 P/F 比值高于非存活者（存活者：209.6±111.4 vs. 非存活者：157.9±96.7；p=0.006）。P/F 比值≥150 的患者 28 天生存率更好（p=0.005）。通过结合 P/F 比值≥150 和 APACHE II 评分＜16，那些在 ICU 入住时具有高 P/F 比值和低 APACHE II 评分的患者与其他患者相比，28 天生存率显著提高（p＜0.001）。这些预后因素也可应用于 90 天生存率（p=0.003）。预测模型在有驱动基因突变的患者中 90 天生存率方面具有显著意义（p=0.021）。
P/F 比值≥150 和 APACHE II 评分＜16 是肺癌合并 DNI 危重症患者的显著预后因素。该预测可应用于有驱动基因突变的患者 90 天生存率。这些发现对临床实践和决策具有重要意义。
