Improved survival of cancer patients admitted to the ICU between 2002 and 2011 at a U.S. teaching hospital

TL;DR

This study shows that survival rates for cancer patients admitted to the ICU improved significantly between 2002 and 2011, likely due to advances in critical and cancer care, with a notable decrease in mortality over time.

Contribution

It provides a comprehensive analysis of ICU admission trends and survival outcomes for cancer patients over a decade using the MIMIC-III database, highlighting improved survival.

Findings

28-day mortality decreased by 30% over the decade

Adjusted odds of mortality for cancer patients declined by 6% annually

Cancer remained a strong predictor of 1-year mortality

Abstract

Over the past decades, both critical care and cancer care have improved substantially. Due to increased cancer-specific survival, we hypothesized that both the number of cancer patients admitted to the ICU and overall survival have increased since the millennium change. MIMIC-III, a freely accessible critical care database of Beth Israel Deaconess Medical Center, Boston, USA was used to retrospectively study trends and outcomes of cancer patients admitted to the ICU between 2002 and 2011. Multiple logistic regression analysis was performed to adjust for confounders of 28-day and 1-year mortality. Out of 41,468 unique ICU admissions, 1,100 hemato-oncologic, 3,953 oncologic and 49 patients with both a hematological and solid malignancy were analyzed. Hematological patients had higher critical illness scores than non-cancer patients, while oncologic patients had similar APACHE-III and SOFA-scores compared to non-cancer patients. In the univariate analysis, cancer was strongly associated with mortality (OR= 2.74, 95%CI: 2.56, 2.94). Over the 10-year study period, 28-day mortality of cancer patients decreased by 30%. This trend persisted after adjustment for covariates, with cancer patients having significantly higher mortality (OR=2.63, 95%CI: 2.38, 2.88). Between 2002 and 2011, both the adjusted odds of 28-day mortality and the adjusted odds of 1-year mortality for cancer patients decreased by 6% (95%CI: 4%, 9%). Having cancer was the strongest single predictor of 1-year mortality in the multivariate model (OR=4.47, 95%CI: 4.11, 4.84).