Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Clinical Characteristics and Prognosis of Lung Cancer Patients Admitted to the Medical Intensive Care Unit at a University Hospital

한 대학병원 내과계 중환자실로 입원한 폐암 환자들의 임상 특성 및 예후

  • Moon, Kyoung Min (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Han, Min Soo (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Lee, Sung Kyu (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Jeon, Ho Seok (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Lee, Yang Deok (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Cho, Yong Seon (Department of Internal Medicine, Eulji University School of Medicine) ;
  • Na, Dong Jib (Department of Internal Medicine, Eulji University School of Medicine)
  • 문경민 (을지대학교 의과대학 내과학교실) ;
  • 한민수 (을지대학교 의과대학 내과학교실) ;
  • 이성규 (을지대학교 의과대학 내과학교실) ;
  • 전호석 (을지대학교 의과대학 내과학교실) ;
  • 이양덕 (을지대학교 의과대학 내과학교실) ;
  • 조용선 (을지대학교 의과대학 내과학교실) ;
  • 나동집 (을지대학교 의과대학 내과학교실)
  • Received : 2008.11.06
  • Accepted : 2008.12.12
  • Published : 2009.01.30
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Abstract

Background: The management of patients with lung cancer has improved recently, and many of them will require admission to the medical intensive care unit (MICU). The aim of this study was to examine the clinical characteristics and to identify risk factors for mortality in patients with lung cancer admitted to the MICU. Methods: We conducted retrospective analysis on 88 patients with lung cancer admitted to the MICU between April 2004 and March 2008. Results: Of the 88 patients (mean age, 66 years), 71 patients (80.7%) had non-small cell lung cancer and 17 patients (19.3%) had small cell lung cancer. Distant metastasis were present in 79 patients (89.8%). The main reasons for MICU admission were acute respiratory failure (77.3%), sepsis (11.4%), and central nervous system dysfunction (4.5%). Mechanical ventilation was used in 54 patients (61.4%). Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of MICU stay, need for mechanical ventilation, source of MICU admission were correlated with MICU mortality. The type of lung cancer and metastasis were not predictive factors of death in MICU. Conclusion: Most common reason for ICU admission was acute respiratory failure. Mortality rate of lung cancer patients admitted to the MICU was 65.9%. APACHE II score, length of ICU stay, need for mechanical ventilation, source of MICU admission were predicted factors of death in the MICU.

연구배경: 최근 중환자실에 입원하여 기계환기 등의 적극적인 치료를 받는 폐암 환자들이 증가하고 있다. 내과계 중환자실에 입원하는 폐암 환자의 임상적인 특성과 사망률에 영향을 미치는 위험 인자에 대하여 알아보고자 하였다. 방 법: 2004년 4월부터 2008년 3월까지 내과계 중환자실에 입원한 폐암 환자 88명을 후향적으로 조사하였다. 결 과: 대상 환자는 88명(평균 나이, 66세)이었으며 비소세포폐암이 71명(80.7%), 소세포폐암이 17명(19.3%)이었다. 79명(89.8%)에서 전이가 있었으며 중환자실에 입원하는 주된 이유로는 급성호흡부전(77.3%), 패혈증(11.4%), 중추신경계 기능장애(4.5%) 순이었다. 54명(61.4%)이 기계환기 치료를 받았다. APACHE II 점수, 중환자실 입원기간, 입원 경로, 기계환기 등과 중환자실 사망률은 유의한 관계가 있었다. 그러나 조직형, 전이 여부 등은 유의한 관계가 없었다. 결 론: 중환자실 사망률은 65.9%이었으며, 중환자실 사망과 유의한 관계가 있는 인자는 APACHE II 점수, 중환자실 입원 기간, 입원 경로, 기계환기 등이었다.

Keywords

References

  1. Soares M, Darmon M, Salluh J, Ferreira C, Thiery G, Schlemmer B, et al. Prognosis of lung cancer patients with life-threatening complications. Chest 2007;131:840-6 https://doi.org/10.1378/chest.06-2244
  2. Adam AK, Soubani AO. Outcome and prognostic factors of lung cancer patients admitted to the medical intensive care unit. Eur Respir J 2008;31:47-53 https://doi.org/10.1183/09031936.00031607
  3. Reichner CA, Thompson JA, O'Brien S, Kuru T, Anderson ED. Outcome and code status of lung cancer patients admitted to the medical ICU. Chest 2006;130:719-23 https://doi.org/10.1378/chest.130.3.719
  4. Sharma G, Freeman J, Zhang D, Goodwin JS. Trends in end-of-life ICU use among older adults with advanced lung cancer. Chest 2008;133:72-8 https://doi.org/10.1378/chest.07-1007
  5. Boussat S, El'rini T, Dubiez A, Depierre A, Barale F, Capellier G. Predictive factors of death in primary lung cancer patients on admission to the intensive care unit. Intensive Care Med 2000;26:1811-6 https://doi.org/10.1007/s001340000701
  6. Claessens MT, Lynn J, Zhong Z, Desbiens NA, Phillips RS, Wu AW, et al. Dying with lung cancer or chronic obstructive pulmonary disease: insight from SUPPORT. Study to understand prognoses and preferences for outcomes and risks of treatments. J Am Geriatr Soc 2000;48:S146-53 https://doi.org/10.1111/j.1532-5415.2000.tb03124.x
  7. Mountain CF. Revision in the international system for staging lung cancer. Chest 1997;111:1710-7 https://doi.org/10.1378/chest.111.6.1710
  8. Demetri G, Elias A, Gershenson D, Fossella F, Grecula J, Mittal B, et al. NCCN Small-cell lung cancer practice guidelines. The national comprehensive cancer network. Oncology 1996;10:179-94
  9. Lim JH, Ban HJ, Oh IJ, Kim SO, Son JG, Jong PJ, et al. Clinical characteristics of lung cancer diagnosed in Chonnam National University Hospital (CNUH) since 2000. Tuberc Respir Dis 2006;61:427-32 https://doi.org/10.4046/trd.2006.61.5.427
  10. Korea National Statistical Office. Annual report on the cause of death statistics. Daejeon: Korea National Statistical Office; 2006. p. 333
  11. Thiery G, Azoulay E, Darmon M, Ciroldi M, de Miranda S, Levy V, et al. Outcome of cancer patients considered for intensive care unit admission: a hospital-wide prospective study. J Clin Oncol 2005;23:4406-13 https://doi.org/10.1200/JCO.2005.01.487
  12. Larche J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G, et al. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 2003;29:1688-95 https://doi.org/10.1007/s00134-003-1957-y
  13. Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB. Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 1999;160:1957-61 https://doi.org/10.1164/ajrccm.160.6.9812055
  14. Groeger JS, White P Jr, Nierman DM, Glassman J, Shi W, Horak D, et al. Outcome for cancer patients requiring mechanical ventilation. J Clin Oncol 1999;17:991-7 https://doi.org/10.1200/JCO.1999.17.3.991
  15. Lin YC, Tsai YH, Huang CC, Hsu KH, Wang SW, Tsao TC, et al. Outcome of lung cancer patients with acute respiratory failure requiring mechanical ventilation. Respir Med 2004;98:43-51 https://doi.org/10.1016/j.rmed.2003.07.009
  16. Soares M, Salluh JI, Spector N, Rocco JR. Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for >24 hrs. Crit Care Med 2005;33:520-6 https://doi.org/10.1097/01.CCM.0000155783.46747.04
  17. Lecuyer L, Chevret S, Thiery G, Darmon M, Schlemmer B, Azoulay E. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med 2007;35:808-14 https://doi.org/10.1097/01.CCM.0000256846.27192.7A
  18. Jennens RR, Rosenthal MA, Mitchell P, Presneill JJ. Outcome of patients admitted to the intensive care unit with newly diagnosed small cell lung cancer. Lung Cancer 2002;38:291-6 https://doi.org/10.1016/S0169-5002(02)00219-2
  19. Janssen-Heijnen ML, Schipper RM, Razenberg PP, Crommelin MA, Coebergh JW. Prevelence of co-morbidity in lung cancer patients and its relationship with treatment: a population-based study. Lung Cancer 1998;21:105-13 https://doi.org/10.1016/S0169-5002(98)00039-7
  20. Jeong ET. Clinical survey of lung cancer in Korea. Tuberc Respir Dis 2000;49:137-48
  21. Martin CM, Hill AD, Burns K, Chen LM. Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays. Crit Care Med 2005;33:1922-7 https://doi.org/10.1097/01.CCM.0000178184.97813.52
  22. Soares M, Salluh JI, Torres VB, Leal JV, Spector N. Short- and long-term outcomes of critically ill patients with cancer and prolonged ICU length of stay. Chest 2008;134:520-6 https://doi.org/10.1378/chest.08-0359
  23. Delle Karth G, Meyer B, Bauer S, Nikfardjam M, Heinz G. Outcome and functional capacity after prolonged intensive care unit stay. Wien Klin Wochenschr 2006;118:390-6 https://doi.org/10.1007/s00508-006-0616-z
  24. Friedrich JO, Wilson G, Clarence C. Long-term outcomes and clinical predictors of hospital mortality in very long stay intensive care unit patients: a cohort study. Critical Care 2006;10:R59 https://doi.org/10.1186/cc4888
  25. Griffin JP, Nelson JE, Koch KA, Niell HB, Ackerman TF, Thompson M, et al. End-of-life care in patients with lung cancer. Chest 2003;123:312S-31S https://doi.org/10.1378/chest.123.1_suppl.312S