Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units

Soo Jin Na; Tae Sun Ha; Younsuck Koh; Gee Young Suh; Shin Ok Koh; Chae-Man Lim; Won-Il Choi; Young-Joo Lee; Seok Chan Kim; Gyu Rak Chon; Je Hyeong Kim; Jae Yeol Kim; Jaemin Lim; Sunghoon Park; Ho Cheol Kim; Jin Hwa Lee; Ji Hyun Lee; Jisook Park; Juhee Cho; Kyeongman Jeon; Validation of Simplified Acute Physiology Score 3 in Korean Intensive care unit (VSKI) study group; Korean Study Group On Respiratory Failure (KOSREF)

doi:10.4266/acc.2018.00143

Characteristics and Clinical Outcomes of Critically Ill Cancer Patients Admitted to Korean Intensive Care Units

Acute Crit Care. 2018 Aug;33(3):121-129. doi: 10.4266/acc.2018.00143. Epub 2018 Aug 31.

Authors

Soo Jin Na¹, Tae Sun Ha², Younsuck Koh³, Gee Young Suh^{1

4}, Shin Ok Koh⁵, Chae-Man Lim³, Won-Il Choi⁶, Young-Joo Lee⁷, Seok Chan Kim⁸, Gyu Rak Chon⁹, Je Hyeong Kim¹⁰, Jae Yeol Kim¹¹, Jaemin Lim¹², Sunghoon Park¹³, Ho Cheol Kim¹⁴, Jin Hwa Lee¹⁵, Ji Hyun Lee¹⁶, Jisook Park¹⁷, Juhee Cho¹⁸, Kyeongman Jeon^{1

4}; Validation of Simplified Acute Physiology Score 3 in Korean Intensive care unit (VSKI) study group; Korean Study Group On Respiratory Failure (KOSREF)

Affiliations

¹ Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
² Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
³ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁵ Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
⁶ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Dongsan Hospital, Keimyung University, Daegu, Korea.
⁷ Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea.
⁸ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea.
⁹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chungju Hospital, Konkuk University School of Medicine, Chungju, Korea.
¹⁰ Department of Critical Care Medicine, Korea University Ansan Hospital, Ansan, Korea.
¹¹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
¹² Division of Pulmonary and Critical Care Medicine, Department of Medicine, Gangneung Asan Hospital, University of Ulsan Medical College of Medicine, Gangneung, Korea.
¹³ Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
¹⁴ Division of Pulmonary and Critical Care Medicine, Department of Medicine, College of Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea.
¹⁵ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
¹⁶ Division of Pulmonary and Critical Care Medicine, Department of Medicine, CHA Bundang Hospital, CHA University, Seongnam, Korea.
¹⁷ Department of Multimedia, Seoul Women's University, Seoul, Korea.
¹⁸ Samsung Advanced Institute of Health Science and Technology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

Background: The objective of this study was to investigate the characteristics and clinical outcomes of critically ill cancer patients admitted to intensive care units (ICUs) in Korea.

Methods: This was a retrospective cohort study that analyzed prospective collected data from the Validation of Simplified Acute Physiology Score 3 (SAPS3) in Korean ICU (VSKI) study, which is a nationwide, multicenter, and prospective study that considered 5,063 patients from 22 ICUs in Korea over a period of 7 months. Among them, patients older than 18 years of age who were diagnosed with solid or hematologic malignancies prior to admission to the ICU were included in the present study.

Results: During the study period, a total of 1,762 cancer patients were admitted to the ICUs and 833 of them were deemed eligible for analysis. Six hundred fifty-eight (79%) had solid tumors and 175 (21%) had hematologic malignancies, respectively. Respiratory problems (30.1%) was the most common reason leading to ICU admission. Patients with hematologic malignancies had higher Sequential Organ Failure Assessment (12 vs. 8, P<0.001) and SAPS3 (71 vs. 69, P<0.001) values and were more likely to be associated with chemotherapy, steroid therapy, and immunocompromised status versus patients with solid tumors. The use of inotropes/vasopressors, mechanical ventilation, and/or continuous renal replacement therapy was more frequently required in hematologic malignancy patients. Mortality rates in the ICU (41.7% vs. 24.6%, P<0.001) and hospital (53.1% vs. 38.6%, P=0.002) were higher in hematologic malignancy patients than in solid tumor patients.

Conclusions: Cancer patients accounted for one-third of all patients admitted to the studied ICUs in Korea. Clinical characteristics were different according to the type of malignancy. Patients with hematologic malignancies had a worse prognosis than did patients with solid tumor.

Keywords: cancer; critical care; epidemiology; hematologic neoplasm; mortality.