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.