Date Published: February 13, 2019
Publisher: Public Library of Science
Author(s): Jin Hwa Song, Sooyeon Kim, Hyun Woo Lee, Yeon Joo Lee, Mi-jung Kim, Jong Sun Park, Yu Jung Kim, Ho Il Yoon, Jae Ho Lee, Jong Seok Lee, Choon-Taek Lee, Young-Jae Cho, Shane Patman.
Intensive care unit (ICU)-related mortality for lung cancer is ranked highest among the solid tumors and little information exists on the role of intensivists on clinical outcomes. This study aimed to elucidate the intensivist’s contribution toward clinical outcomes.
Data of advanced lung cancer patients, including stage IIIB or IV non-small cell lung cancer and extensive-stage small cell lung cancer, admitted to the ICU from 2005 to 2016 were analyzed. Multivariate logistic regression was performed to determine variables associated with ICU and in-hospital mortality. Autoregressive integrated moving average (ARIMA) for time-series was used to assess the intensivist’s impact.
Of 264 patients, 85 (32.2%) were admitted to the ICU before and 179 (67.8%) after organized intensive care introduction in 2011. Before and after 2011, the changes observed were as follows: ICU mortality rate, 43.5% to 40.2%, respectively (p = 0.610); hospital mortality rate, 82.4% to 65. 9% (p = 0.006). The duration of ICU and hospital stay decreased after 2011 (14.5±16.5 vs. 8.3 ± 8.6, p < 0.001; 36.6 ± 37.2 vs. 22.0 ± 19.6, p < 0.001). On multivariate analysis, admission after 2011 was independently associated with decreased hospital mortality (Odds ratio 0.42, 95% confidence interval 0.21–0.77, p = 0.006). In ARIMA models, intensivist involvement was associated with significantly reduced hospital mortality. (Estimate -17.95, standard error 5.31, p = 0.001) In patients with advanced lung cancer, organized intensive care could contribute to improved clinical outcomes.
Lung cancer is the leading cause of cancer death in South Korea  and worldwide . Moreover, it is the most common cause of intensive care unit (ICU) admission among solid tumors, and the number of admissions has increased over time in the United States [3, 4]. The critical illness in lung cancer patients is mainly associated with respiratory dysfunction due to multiple reasons: 1) cancer-related complications, such as airway obstruction or bleeding, pulmonary embolism, superior vena cava syndrome, and neurologic problems; 2) treatment-related complications, such as radiation pneumonitis and anti-tumor drug-induced interstitial pneumonia; and 3) infections, especially obstructive pneumonia . Patients with lung cancer often require intensive care due to the aggressive nature of the disease.
Our study demonstrated that the implementation of the intensivist system reduced hospital mortality, ICU LOS, and hospital LOS in advanced lung cancer patients. These results were consistent in the time series analyses besides the crude analysis comparing pre- and post-2011. Admission of patients with advanced lung cancer increased steadily over the years and there was no significant difference in severity scores (SAPS II, APACHE II, and SOFA scores on day 1). Survival rate improved after 2011, that is, after introduction of the intensivist.