Short- and long-term mortality in critically ill patients with solid cancer. The Vall d'Hebron Intensive Care Unit-Vall d'Hebron Institute of Oncology Cohort: a retrospective study.

Abstract

Objective: To describe in-hospital and one-year mortality and to identify prognostic variables associated with mortality.

Design: Retrospective cohort study.

Setting: Tertiary referral hospital in Barcelona (Spain).

Patients: Consecutive patients with solid cancer and unplanned admission to the ICU over a ten year period (2010-2019).

Main variables of interest: In-hospital mortality, one-year mortality, type of cancer, metastatic disease, ECOG, APACHE, SOFA, invasive mechanical ventilation, vasoactive drugs, renal replacement therapy.

Results: Three hundred and ninety-five patients were admitted to the ICU; 193 (48.8%) had metastatic disease, and 22 (5.9%) presented neutropenia. The median SOFA score on day 1 of ICU admission was 6 (3-9). ICU, in-hospital, and one-year mortality were 27.9% (110 patients), 39% (139 patients), and 61.1% (236 patients), respectively. A non-surgical admission, a higher ECOG, a SOFA score > 9 on day 1, a non-decreasing SOFA score on day 5, and requiring invasive mechanical ventilation were factors associated with in-hospital mortality. ECOG, inability to resume anticancer therapy, and ICU admission due to respiratory failure were associated with one-year mortality in hospital survivors.

Conclusion: Survival in critically ill solid cancer patients is substantial, even when metastatic disease exists. Short-term outcomes were associated with ECOG and organ dysfunction, not cancer per se. The prognosis of patients with a non-decreasing SOFA score on day 5 is poor, especially when the SOFA score on day 1 was >9. Long-term mortality was associated with functional status and inability to resume anticancer therapy.