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Abstract：
BACKGROUND: The prognosis of patients with lung cancer admitted to the intensive care unit (ICU) is often perceived as poor. We described the characteristics, management, and outcomes of critically ill patients with lung cancer and determined the predictors of mortality.
METHODS: We retrospectively studied patients with lung cancer who were admitted to the ICU of a tertiary care hospital between 1999 and 2021 for the reasons other than routine postoperative care. We noted their characteristics, ICU management, and outcomes. We performed the multivariable logistic regression analysis to determine the predictors of hospital mortality.
RESULTS: In the 23-year period, 306 patients with lung cancer were admitted to the ICU (median age = 63.0 years, 68.3% males, 45.6% with moderate/severe functional disability, most had advanced lung cancer, and median Acute Physiology and Chronic Health Evaluation II score = 24.0). Life support measures included invasive mechanical ventilation (47.1%), vasopressors (34.0%), and new renal replacement therapy (8.8%). Do-Not-Resuscitate orders were implemented during ICU stay in 30.1%. The hospital mortality was 43.8% with a significantly lower rate in patients admitted after 2015 (28.0%). The predictors of mortality were moderate/severe baseline disability (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.22, 5.78), advanced lung cancer (OR 8.36, 95% CI 1.81, 38.58), lactate level (OR 1.45, 95% CI 1.12, 1.88, invasive mechanical ventilation (OR 10.92, 95% CI 4.98, 23.95), and admission period after 2015 (OR 0.37, 95% CI 0.16, 0.85).
CONCLUSIONS: The mortality rates in patients with lung cancer admitted to the ICU during a 23-year period decreased after 2015. Functional disability, advanced lung cancer stage, vasopressor use, and invasive mechanical ventilation predicted mortality.
METHODS: We retrospectively studied patients with lung cancer who were admitted to the ICU of a tertiary care hospital between 1999 and 2021 for the reasons other than routine postoperative care. We noted their characteristics, ICU management, and outcomes. We performed the multivariable logistic regression analysis to determine the predictors of hospital mortality.
RESULTS: In the 23-year period, 306 patients with lung cancer were admitted to the ICU (median age = 63.0 years, 68.3% males, 45.6% with moderate/severe functional disability, most had advanced lung cancer, and median Acute Physiology and Chronic Health Evaluation II score = 24.0). Life support measures included invasive mechanical ventilation (47.1%), vasopressors (34.0%), and new renal replacement therapy (8.8%). Do-Not-Resuscitate orders were implemented during ICU stay in 30.1%. The hospital mortality was 43.8% with a significantly lower rate in patients admitted after 2015 (28.0%). The predictors of mortality were moderate/severe baseline disability (odds ratio [OR] 2.65, 95% confidence interval [CI] 1.22, 5.78), advanced lung cancer (OR 8.36, 95% CI 1.81, 38.58), lactate level (OR 1.45, 95% CI 1.12, 1.88, invasive mechanical ventilation (OR 10.92, 95% CI 4.98, 23.95), and admission period after 2015 (OR 0.37, 95% CI 0.16, 0.85).
CONCLUSIONS: The mortality rates in patients with lung cancer admitted to the ICU during a 23-year period decreased after 2015. Functional disability, advanced lung cancer stage, vasopressor use, and invasive mechanical ventilation predicted mortality.
摘要：
背景：重症监护病房（ICU）收治的肺癌患者的预后通常被认为较差。我们描述了特点，管理,和重症肺癌患者的结局，并确定死亡率的预测因素。
方法：我们回顾性研究了1999年至2021年因常规术后护理以外的原因进入三级医院ICU的肺癌患者。我们注意到它们的特点，ICU管理,和结果。我们进行了多变量逻辑回归分析，以确定医院死亡率的预测因素。
结果：在23年期间，306例肺癌患者入住ICU（中位年龄=63.0岁，68.3%男性，45.6％患有中度/重度功能性残疾，大多数人患有晚期肺癌，和中位急性生理学和慢性健康评估II评分=24.0）。生命支持措施包括有创机械通气（47.1%），血管升压药（34.0%），和新的肾脏替代治疗(8.8%)。30.1%的患者在ICU住院期间实施了不复苏令。医院死亡率为43.8％，2015年后住院患者的死亡率显着降低（28.0％）。死亡率的预测因素是中度/重度基线残疾(比值比[OR]2.65,95%置信区间[CI]1.22,5.78),晚期肺癌（OR8.36，95%CI1.81，38.58），乳酸水平（OR1.45，95%CI1.12，1.88，有创机械通气（OR10.92，95%CI4.98，23.95），和2015年后的入院期(OR0.37，95%CI0.16，0.85)。
结论：2015年后，入住ICU23年的肺癌患者死亡率下降。功能性残疾,晚期肺癌阶段，血管加压药的使用,有创机械通气可预测死亡率。
方法：我们回顾性研究了1999年至2021年因常规术后护理以外的原因进入三级医院ICU的肺癌患者。我们注意到它们的特点，ICU管理,和结果。我们进行了多变量逻辑回归分析，以确定医院死亡率的预测因素。
结果：在23年期间，306例肺癌患者入住ICU（中位年龄=63.0岁，68.3%男性，45.6％患有中度/重度功能性残疾，大多数人患有晚期肺癌，和中位急性生理学和慢性健康评估II评分=24.0）。生命支持措施包括有创机械通气（47.1%），血管升压药（34.0%），和新的肾脏替代治疗(8.8%)。30.1%的患者在ICU住院期间实施了不复苏令。医院死亡率为43.8％，2015年后住院患者的死亡率显着降低（28.0％）。死亡率的预测因素是中度/重度基线残疾(比值比[OR]2.65,95%置信区间[CI]1.22,5.78),晚期肺癌（OR8.36，95%CI1.81，38.58），乳酸水平（OR1.45，95%CI1.12，1.88，有创机械通气（OR10.92，95%CI4.98，23.95），和2015年后的入院期(OR0.37，95%CI0.16，0.85)。
结论：2015年后，入住ICU23年的肺癌患者死亡率下降。功能性残疾,晚期肺癌阶段，血管加压药的使用,有创机械通气可预测死亡率。
