Data from: Short-term and medium-term survival of critically ill patients with solid tumours admitted to the intensive care unit: a retrospective analysis

Objectives: Patients with cancer frequently require unplanned admission to the Intensive Care Unit (ICU). Our objectives were to assess hospital and 180-day mortality in patients with a non-haematological malignancy and unplanned ICU admission, and to identify which factors present on admission were the best predictors of mortality. Design: Retrospective review of all patients with a diagnosis of solid tumours following unplanned admission to the ICU between 1st August 2008 and 31st July 2012. Setting: Single centre tertiary care hospital in London (UK) Participants: 300 adult patients with non-haematological solid tumours requiring unplanned admission to the ICU. Interventions: None Primary and secondary outcomes: Hospital and 180-day survival Results: 300 patients were admitted to the ICU (median age 66.5 years; 61.7% male). Survival to hospital discharge and 180-days were 69% and 47.8%, respectively. Greater number of failed organ systems on admission was associated with significantly worse hospital survival (p<0.001) but not with 180-day survival (p=0.24). In multivariate analysis, predictors of hospital mortality were the presence of metastases [odds ratio (OR 1.97), 95% confidence interval (CI) 1.08-3.59], Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR 1.07, 95% CI 1.01-1.13) and a Glasgow Coma Scale score <7 on admission to ICU (OR 5.21, 95% CI 1.65-16.43). Predictors of worse 180-day survival were the presence of metastases (OR 2.82, 95% CI 1.57-5.06), APACHE II score (OR 1.07, 95% CI 1.01-1.13) and sepsis (OR 1.92, 95% CI 1.09-3.38). Conclusions: Short and medium-term survival in patients with solid tumours admitted to ICU is better than previously reported, suggesting that the presence of cancer alone should not be a barrier to ICU admission.

研究目的：癌症患者常需非计划入住重症监护病房（Intensive Care Unit, ICU）。本研究旨在评估非血液系统恶性肿瘤患者非计划入住ICU后的住院死亡率及180天死亡率，并明确入院时的哪些因素可作为死亡率的最佳预测因子。
研究设计：对2008年8月1日至2012年7月31日期间非计划入住ICU的实体瘤患者开展回顾性审查。
研究场景：英国伦敦的单中心三级医疗医院。
研究对象：300例需非计划入住ICU的成人非血液系统实体瘤患者。
干预措施：无。
主要及次要结局：住院生存率与180天生存率。
研究结果：共纳入300例ICU入住患者，中位年龄66.5岁，男性占比61.7%。患者住院出院生存率及180天生存率分别为69%和47.8%。入院时衰竭器官系统数量越多，住院生存率显著降低（p<0.001），但与180天生存率无显著关联（p=0.24）。多变量分析显示，住院死亡率的预测因子包括转移灶存在[比值比（OR 1.97），95%置信区间（CI 1.08-3.59）]、急性生理学与慢性健康状况评分系统II（Acute Physiology and Chronic Health Evaluation II, APACHE II）评分（OR 1.07，95%CI 1.01-1.13）以及入住ICU时格拉斯哥昏迷量表（Glasgow Coma Scale）评分<7分（OR 5.21，95%CI 1.65-16.43）。180天生存率较差的预测因子包括转移灶存在（OR 2.82，95%CI 1.57-5.06）、APACHE II评分（OR 1.07，95%CI 1.01-1.13）以及脓毒症（OR 1.92，95%CI 1.09-3.38）。
研究结论：实体瘤患者入住ICU后的短期及中期生存率优于既往报道，提示仅罹患癌症不应作为ICU入住的禁忌证。