Risk factors and mortality of adults with lung cancer admitted to the intensive care unit

Background: This study aims to investigate lung cancer patients' risk factors for: intensive care unit (ICU) admission, infectious complications and organ dysfunction in the ICU, and prognosis after ICU admission. Methods: The records of all patients with lung-cancer catastrophic-illness cards admitted to the ICU between 2003 and 2012 were reviewed. The primary endpoint was 1-year mortality. Results: We finally analyzed the records of index-date-, age-, and sex-matched ICU-admitted (ICU+) lung cancer patients (n=17,687) and ICU-non-admitted (ICU-) lung cancer patients (n=35,374). The overall 1-year mortality rate was significantly (P<0.0001) higher for ICU+ patients (49.91%) than for ICU- patients (44.86%). Most ICU+ patients (56.16%) had infectious complications and organ dysfunction (52.33%), and overall, 6,893 (38.97%) had sepsis. Independent mortality risk factors were age (≥75 years) [adjusted hazard ratio (AHR), 1.22; 95% confidence interval (CI), 1.16-1.29], male sex: (AHR, 1.18; 95% CI, 1.13-1.23), recent radiotherapy (AHR, 1.09; 95% CI, 1.04-1.15), infectious complications (AHR: 1.23; 95% CI: 1.17- 1.29), organ dysfunction (AHR, 1.57; 95% CI, 1.50-1.65), and hospital level (regional hospital: AHR, 1.11; 95% CI, 1.06-1.16; local hospital: AHR, 1.28; 95% CI, 1.18-1.37). Conclusions: ICU admission for lung cancer patients is associated with higher mortality. Several risk factors of mortality for ICU+M patients should help physicians provide patients personalized and betterinformed lung cancer therapy decisions. ©Journal of Thoracic Disease.