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OUTCOME AND PROGNOSTIC FACTORS OF LUNG CANCER PATIENTS ADMITTED TO A MEDICAL INTENSIVE CARE UNIT

Wayne State University, Detroit, MI

PURPOSE: To assess the outcome of lung cancer patients who were admitted to a medical ICU (MICU), and to identify the measurable predictors of their MICU outcome.

METHODS: Design: Retrospective chart review study.Setting: University based hospitals MICUsPatients: Lung cancer patients admitted to the MICU between January 1998 and October 2005.

RESULTS: 139 lung cancer patients were admitted to the MICU during the study period. Their mean age (±SD) was 64.2 ± 10.2 years (men 48%, women 52%). 96 patients (69%) had non-small cell lung cancer, 18 patients (13%) had small cell lung cancer, one patient had mesothelioma, the type of lung cancer could not be determined in the rest (24 patients). 108 patients (78%) survived their MICU stay, and 83 patients (60%) discharged alive from the hospital. The long-term survival rate (i.e., >6months) in this cohort was 16%. 68 patients (49%) required mechanical ventilation (MV), 42 patients (62%) mechanically ventilated patients survived their MICU stay. The predictors of poor MICU outcome were the need for MV, the use of vasopressors, positive blood cultures, serum lactate of 2mg/dL or more, the presence of two or more organ failure, and the need for ACLS.

CONCLUSION: The study showed the MICU outcome of lung cancer patients is favorable. While there were no absolute predictors of mortality, higher MICU admission serum lactate levels, MV, positive blood culture, hemodynamic instability requiring vasopressors, and the development of multi organ system failure (MOSF) were associated with poor MICU outcome.

CLINICAL IMPLICATIONS: Intensive care and MV for lung cancer patients should not be regarded as futile care, and thier MICU outcome is reasonable. There are no absolute predictors of mortality, however, those patients with elevated serum lactate levels on admission to MICU, positive blood culture, those who require MV or vasopressors, and those who develop MOSF are less likely to survive.

DISCLOSURE: Abdulgadir Adam, None.