Six-month prognosis of patients with lung cancer admitted to the intensive care unit

Intensive Care Med. 2009 Dec;35(12):2044-50. doi: 10.1007/s00134-009-1625-y. Epub 2009 Sep 19.


Background: Intensive care unit (ICU) admission of patients with lung cancer remains debated because of the poor short-term prognosis. However, ICU admission of such patients should also be assessed on the possibility to administer specific anticancer treatment and the long-term outcome thereafter.

Objectives: To identify predictive factors of hospital and 6-month mortality in critically ill lung-cancer patients.

Design and setting: Retrospective study conducted in the ICU of a university hospital.

Patients: One hundred five consecutive lung-cancer patients included between 1 January 1997 and 31 December 2006.

Interventions: None.

Results: Of the 105 patients (mean age 64.8 years), 87 (83%) had a non-small cell lung cancer (NSCLC). Extensive disease was diagnosed in 85 patients (83%) (NSCLC stages IIIB and IV or disseminated small cell lung cancer). The main reasons for ICU admission were acute respiratory failure (59%) and/or hemoptysis (45%). Forty-three patients (41%) needed mechanical ventilation (MV). The ICU, hospital and 6-month mortality rates were 43, 54 and 73%, respectively. A performance status (PS) >or=2 [odds ratio OR = 3.6 (95% confidence interval CI (1.5-8.7)] and acute respiratory failure [OR = 3.5 (95% CI (1.5-8.4)] predicted hospital mortality. In a multivariate Cox model, the cancer progression [hazard ratio HR = 6.1 (95% CI 2.2-17)] and the need for MV [HR = 3.6 (95% CI 1.35-9.4)] were independently associated with 6-month mortality. Two-thirds of the ICU survivors were able to receive anticancer treatment.

Conclusions: ICU admission should be considered in selected patients with lung cancer (PS <2, no cancer disease progression).

MeSH terms

  • Acute Disease
  • Cardiovascular Diseases / epidemiology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data*
  • Karnofsky Performance Status
  • Lung Neoplasms / mortality*
  • Lung Neoplasms / rehabilitation*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Patient Admission / statistics & numerical data*
  • Prognosis
  • Pulmonary Disease, Chronic Obstructive / epidemiology
  • Respiratory Insufficiency / epidemiology
  • Respiratory Insufficiency / rehabilitation
  • Severity of Illness Index
  • Survival Rate
  • Time Factors