Al-Dorzi Hasan M, Atham Sadeem, Khayat Faten, Alkhunein Jullanar, Alharbi Bushra T, Alageel Norah, Tlayjeh Mohamed, Tlayjeh Haytham, Arabi Yaseen M
Department of Intensive, King Abdulaziz Medical City, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Ann Thorac Med. 2024 Jul-Sep;19(3):208-215. doi: 10.4103/atm.atm_287_23. Epub 2024 Jul 4.
The prognosis of patients with lung cancer admitted to the intensive care unit (ICU) is often perceived as poor. We described the characteristics, management, and outcomes of critically ill patients with lung cancer and determined the predictors of mortality.
We retrospectively studied patients with lung cancer who were admitted to the ICU of a tertiary care hospital between 1999 and 2021 for the reasons other than routine postoperative care. We noted their characteristics, ICU management, and outcomes. We performed the multivariable logistic regression analysis to determine the predictors of hospital mortality.
In the 23-year period, 306 patients with lung cancer were admitted to the ICU (median age = 63.0 years, 68.3% males, 45.6% with moderate/severe functional disability, most had advanced lung cancer, and median Acute Physiology and Chronic Health Evaluation II score = 24.0). Life support measures included invasive mechanical ventilation (47.1%), vasopressors (34.0%), and new renal replacement therapy (8.8%). Do-Not-Resuscitate orders were implemented during ICU stay in 30.1%. The hospital mortality was 43.8% with a significantly lower rate in patients admitted after 2015 (28.0%). The predictors of mortality were moderate/severe baseline disability (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.22, 5.78), advanced lung cancer (OR 8.36, 95% CI 1.81, 38.58), lactate level (OR 1.45, 95% CI 1.12, 1.88, invasive mechanical ventilation (OR 10.92, 95% CI 4.98, 23.95), and admission period after 2015 (OR 0.37, 95% CI 0.16, 0.85).
The mortality rates in patients with lung cancer admitted to the ICU during a 23-year period decreased after 2015. Functional disability, advanced lung cancer stage, vasopressor use, and invasive mechanical ventilation predicted mortality.
入住重症监护病房（ICU）的肺癌患者的预后通常被认为较差。我们描述了重症肺癌患者的特征、治疗及预后情况，并确定了死亡的预测因素。
我们回顾性研究了1999年至2021年间因非常规术后护理原因入住一家三级医院ICU的肺癌患者。我们记录了他们的特征、ICU治疗情况及预后。我们进行多变量逻辑回归分析以确定医院死亡的预测因素。
在这23年期间，306例肺癌患者入住ICU（中位年龄 = 63.0岁，68.3%为男性，45.6%有中度/重度功能残疾，大多数为晚期肺癌，急性生理与慢性健康状况评分II中位数 = 24.0）。生命支持措施包括有创机械通气（47.1%）、血管活性药物（34.0%）和新的肾脏替代治疗（8.8%）。30.1%的患者在ICU住院期间实施了“不进行心肺复苏”医嘱。医院死亡率为43.8%，2015年后入院的患者死亡率显著较低（28.0%）。死亡的预测因素为中度/重度基线残疾（比值比[OR] 2.65，95%置信区间[CI] 1.22，5.78）、晚期肺癌（OR 8.36，95% CI 1.81，38.58）、乳酸水平（OR 1.45，95% CI 1.12，1.88）、有创机械通气（OR 10.92，95% CI 4.98，23.95）以及2015年后的入院时间（OR 0.37，95% CI 0.16，0.85）。
在23年期间，2015年后入住ICU的肺癌患者死亡率有所下降。功能残疾、肺癌晚期、血管活性药物的使用及有创机械通气可预测死亡率。
