Long term outcome of patients with solid tumours following non surgical critical care admission


Year:

Session type:

Katherine Murphy1,Phil Haji-Michael2
1University of Manchester,2The Christie

Abstract

Background

Patients with cancer are increasingly admitted to the intensive care unit, with wide ranging outcomes previously reported.

Method

Our study focussed on a subset of these patients: unplanned medical ICU admissions in patients diagnosed with a solid tumour, hereby anticipating reduced heterogeneity and production of more meaningful results. The aim was to identify factors apparent within the first 12 hours of admission that could best act as prognostic indicators in this group.

Results

Retrospective study of all solid tumour patients with unplanned medical admissions to a single tertiary critical care unit between 2009 and 2015.408 patients were included (median age 63 years, 55.4% male). Survival to ICU discharge, hospital discharge and 1 year were 73.3%, 58.1% and 26.2%, respectively. On multivariate analysis, the factors associated with significantly worse 1 year survival were age (Exp(B) 1.011), presence of metastases (Exp(B) 1.793), GCS of ≤ 7 (Exp(B) 7.207), pancreatic tumour (Exp(B) 5.724), lung tumour (Exp(B) 3.942), and pneumonia (Exp(B) 5.391). Variations when compared to ICU survival were only seen in total organ support, with more organ support directly correlated to increased mortality at this interval. ICNARC is superior to APACHE II with regards to ICU mortality probability; though both are poor prognostic tests (AUC 0.678 and 0.590, respectively).

Conclusion

Our results reiterate that survival in this group is better than previously thought, with severity of acute illness playing an important role. Therefore, cancer alone should not prevent ICU admission.