by Frédéric
Gonzalez, Rémi Starka, Laurent Ducros, Magali Bisbal, Laurent Chow-Chine, Luca
Servan, Jean-Manuel de Guibert, Bruno Pastene, Marion Faucher, Antoine Sannini,
Marc Leone and Djamel Mokart
Annals of
Intensive Care volume 13,
Article number: 73 (2023)
Background
Data about
critically ill metastatic cancer patients functional outcome after unplanned
admission to the ICU are scarce. The aim of this study was to assess factors
associated with 90-day return home and 1-year survival in this population.
Study design and
methods
A multicenter
retrospective study included all consecutive metastatic cancer patients
admitted to the ICU for unplanned reason between 2017 and 2020.
Results
Among 253 included
metastatic cancer patients, mainly with lung cancer, 94 patients (37.2%)
could return home on day 90. One-year survival rate was 28.5%. Performance
status 0 or 1 (OR, 2.18; 95% CI 1.21–3.93; P = 0.010), no malnutrition
(OR, 2.90; 95% CI 1.61–5.24; P < 0.001), female gender (OR, 2.39; 95%
CI 1.33–4.29; P = 0.004), recent chemotherapy (OR, 2.62; 95% CI
1.40–4.90; P = 0.003), SOFA score ≤ 5 on admission (OR, 2.62; 95% CI
1.41–4.90; P = 0.002) were significantly predictive for 90-day return
home. Malnutrition (HR, 1.66; 95% CI 1.18–2.22; P = 0.003), acute
respiratory failure (ARF) as reason for admission (HR, 1.40; 95% CI
1.10–1.95; P = 0.043), SAPS II on admission (HR, 1.03; 95% CI
1.02–1.05; P < 0.001) and decisions to forgo life-sustaining therapies
(DFLST) (HR, 2.80; 95% CI 2.04–3.84; P < 0.001) were independently
associated with 1-year mortality.
Conclusions
More than one out
of three metastatic cancer patients could return home within 3 months after an
unplanned admission to the ICU. Previous performance and nutritional status,
ongoing specific treatment and low severity of the acute illness were found to
be predictive for return home. Such encouraging findings should help change the
dismal perception of critically ill metastatic cancer patients.
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