Outcome of Patients with Solid Malignancies Considered for Intensive Care Unit Admission: A Single-Center Prospective Cohort Study

Abstract

Abstract Purpose To identify the predictors and outcomes of ICU triage decisions in patients with solid malignancies (SM) and to investigate the usefulness of the National Early Warning Score (NEWS) and quick Sequential Organ Failure Assessment (qSOFA) score at triage. Methods All patients with SM for whom ICU admission was requested between July 2019 and December 2021 in a French university-affiliated hospital were included prospectively. Results Of the 6262 patients considered for ICU admission, 410 (6.5%) had SM (age, 66 [58–73] years; metastases, 60.1%; and performance status 0–2, 81%). Of these 410 patients, 176 (42.9%) were admitted to the ICU, including 141 (80.1%) who were discharged alive. Breast cancer, hemoptysis, and pneumothorax were associated with ICU admission; whereas older age, poor general health, metastatic disease, and request at night were associated with denial of ICU admission. The NEWS, and the qSOFA score in patients with suspected infection, determined at triage performed poorly for predicting hospital mortality (area under the receiver operating characteristics curve, 0.52 and 0.62, respectively). Poor general health was independently associated with higher 6-month mortality and first-line anticancer treatment with lower 6-month mortality. Hospital mortality was 33.3% in patients admitted to the ICU after refusal of the first request. Conclusion Patients with SM were frequently denied ICU admission despite excellent in-ICU survival. Poor chronic health status was associated with ICU admission denial and higher 6-month mortality, but none of the other reasons for denying ICU admission predicted 6-month mortality. Physiological scores had limited usefulness in this setting.