Prognosis of Patients with Lung Cancer Admitted to the Intensive Care Unit: A Systematic Review and Meta-Analysis

Introduction Despite recent advances in the care of critically ill patients with cancer, studies show that lung cancer is associated with higher Intensive Care Unit (ICU) mortality than other types of cancer. This systematic review and meta-analysis aim to investigate the ICU outcomes and predictors of mortality in critically ill patients with lung cancer. Methods PubMed, OVID MEDLINE, Cochrane and Embase were searched to identify relevant studies. The primary outcome was ICU mortality. The secondary outcomes were hospital mortality and predictors of mortality. Abstracts, case reports and case series were excluded. Results Thirty-three studies met inclusion criteria, including 28 cohort studies (n = 4123) and five population-based studies (n = 82,475). The pooled ICU mortality was 46.4% (95% CI 41.0-51.8; n = 16,772). The pooled hospital mortality was 51.9% (95% CI 46.9-56.9; n = 72,215). The pooled long-term mortality (6-12 months) was 73.5%, (95% CI 68.2- 78.2; n = 84,008). Predictors of mortality included the presence of metastatic disease (RR 1.30, 95% CI 1.06-1.59), poor performance status (RR 1.33, 95% CI 1.12-1.57), requirement for mechanical ventilation (RR 2.25, 95% CI 1.58-3.21), requirement for vasopressors (RR 1.95, 95% CI 1.54-2.46), higher APACHE or SAPS score (standardized mean difference 0.63, 95% CI 0.45-0.80), and higher SOFA score (mean difference 1.95, 95% CI 1.21-2.70). Conclusion Critically ill patients with lung cancer have reasonable short term but poor long-term outcome. Focused and early goals of care discussions are crucial part of ICU care in this patient population.