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Prognosis of Lung Cancer Patients With Life-Threatening Complications^*

^* From the Intensive Care Unit (Drs. Soares and Salluh), Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Service de Reanimation Medicale (Drs. Darmon, Thíéry, Schlemmer, and Azoulay), Hopital Saint-Louis et Universite Paris 7, Assistance Publique, Hôpitaux de Paris, France; Department of Clinical Research (Dr. Ferreira), Instituto Nacional de Câncer, Rio de Janeiro, Brazil; and Faculdade de Medicina (Dr. Spector), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

Correspondence to: Márcio Soares, MD, PhD, Instituto Nacional de Câncer, Centro de Tratamento Intensivo, 10° Andar; Pça. Cruz Vermelha, 23, Rio de Janeiro, Brazil; e-mail: marciosoaresms{at}yahoo.com.br

Abstract

Background: The management of patients with lung cancer has improved recently, and many of them will require admission to the ICU. The aims of this study were to determine hospital mortality and to identify risk factors for death in a large cohort of critically ill patients.

Methods: Cohort study in two ICUs specialized in the management of patients with cancer, in France and Brazil.

Results: Of the 143 patients (mean age, 61.6 ± 9.9 years [± SD]), 25 patients (17%) had small cell lung cancer and 118 patients (83%) had non-small cell lung cancer. The main reasons for ICU admission were sepsis (44%) and acute respiratory failure (31%). Mechanical ventilation (MV) was used in 100 patients (70%), including 38 patients in whom lung cancer was considered a reason for MV. Hospital mortality was 59% overall and 69% in patients receiving MV. By multivariate logistic regression, airway infiltration or obstruction by cancer, number of organ failures, cancer recurrence or progression, and severity of comorbidities were associated with increased mortality.

Conclusions: The improved survival previously reported in patients with cancer admitted to the ICU seems to extend to patients with lung cancer, including those who need MV. Mortality increased with the number of organ failures, severity of comorbidities, and presence of respiratory failure due to cancer progression. The type of the cancer per se was not associated with mortality and, therefore, should not be factored into ICU triage decisions.

Key Words: acute respiratory failure • intensive care • lung cancer • mechanical ventilation • outcome