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Outcome and prognostic factors of lung cancer patients admitted to the medical intensive care unit

¹ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, and ² Wayne State University School of Medicine and Karmanos Cancer Center, Detroit, MI, USA.

CORRESPONDENCE: A. O. Soubani, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, 3990 John R- 3 Hudson, Detroit, MI 48201, USA, Fax: 1 3139930562. E-mail: asoubani{at}med.wayne.edu

Keywords: Lung cancer, mechanical ventilation, medical intensive care unit, multi-organ system failure, outcome, prognosis

Received: March 15, 2007
Accepted August 6, 2007

The aim of the present study was to assess the outcome of lung cancer patients who were admitted to a medical intensive care unit (MICU) and to identify the measurable predictors of their MICU outcome.

The retrospective study took place at the MICUs of a university-affiliated medical centre and involved adult lung cancer patients admitted to the MICU between January 1998 and October 2005.

A total of 139 lung cancer patients were included during the study period. The mean age±SD at MICU admission was 64.2±10.2 yrs (48% males, 52% females). In total, 96 (69%) patients had nonsmall cell lung cancer, 18 (13%) patients had small cell lung cancer, and one patient had mesothelioma. The MICU mortality was 22% (31 patients), while the in-hospital mortality was 40% (56 patients). Sixty-eight (49%) patients required mechanical ventilation (MV), with MICU mortality of 38% and in-hospital mortality of 53%. The independent predictors of poor MICU outcome were: the need for MV; Acute Physiology And Chronic Health Evaluation III and Simplified Acute Physiology Score III scores; the use of vasopressors; positive blood cultures; high serum lactate; two or more organ system failures; and the need for adult cardiac life support. On multivariate analysis, only the need for vasopressors and the presence of two or more organ system failures predicted poor MICU outcome.

The present study shows that the medical intensive care unit outcome of lung cancer patients is better than previously reported. Intensive care and mechanical ventilation should not be considered futile care in this patient population. While there were no absolute predictors of mortality, the need for vasopressors and the presence of two or more organ system failures predicted poor medical intensive care unit care.