This study aimed to record the 30 and 90-day mortalities for patients with a metastatic solid organ malignancy requiring an unplanned medical admission to intensive care. Secondary aims included the identification of factors predictive of mortality including the previously published ‘Oncoscore’.
A retrospective study was conducted across two Australian hospitals between 2014 and 2018 utilising the Australian and New Zealand Intensive Care Society Adult Patient Database to identify all patients with advanced solid organ malignancy and an unplanned medical ICU admission. Demographic, clinical, interventional, biochemical and outcome data was extracted. Additional data was sourced from the patient’s medical records.
A total of 138 admissions were included with a mean age of 67 years; 56% were female. The 30 and 90-day mortalities were 42% and 55% respectively. In separate 30 and 90-day multivariate analyses, a patient’s APACHE III score (30-day odds ratio [OR]=1.04 (95%CI, 1.02–1.06); 90-day OR=1.03 (95%CI, 1.01–1.02)) and non-invasive ventilation (NIV)(30-day OR=13.63 (95%CI, 4.85–38.27); 90-day OR=5.50 (95%CI, 2.12–14.29)) were significant mortality predictors. By logistic regression the ‘Oncoscore’ was predictive of 30-day (P=0.016) but not 90-day mortality. Lowest albumin was significant for both 30-day (P=0.016) and 90-day (P=0.009) mortality. Cox regression analysis showed that invasive and non-invasive ventilation were also significant for 30-day (P=0.002; P=0.009) and 90-day (P≤0.001; P≤0.001) mortality.
Unplanned intensive care admissions for medical issues in oncology patients with metastatic cancer had high, but not futile, 30 and 90-day mortalities. A high APACHE III score, low albumin at intensive care admission or the need for assisted ventilation were all prognostic markers of poor outcome. Poor outcomes with NIV may represent a “ceiling of care” where invasive ventilation is not provided due to expected futility. Understanding potential outcomes during and after ICU admission are important when considering patient goals of care.