Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;68(6):740-748.
doi: 10.4187/respcare.10604. Epub 2023 Apr 18.

Etiologies and Outcome of Patients with Solid Tumors Admitted to ICU with Acute Respiratory Failure: A Secondary Analysis of the EFRAIM Study

Soraya Benguerfi  1 , Guillaume Dumas  2 , Marcio Soares  3 , Anne-Pascale Meert  4 , Ignacio Martin-Loeches  5 , Frederic Pene  6 , Philippe Bauer  7 , Sangeeta Mehta  8 , Victoria Metaxa  9 , Gaston Burghi  10 , Achille Kouatchet  11 , Luca Montini  12 , Djamel Mokart  13 , Andry Van de Louw  14 , Elie Azoulay  2 , Virginie Lemiale  2 ; EFRAIM investigators and Nine-I study group
Affiliations

Etiologies and Outcome of Patients with Solid Tumors Admitted to ICU with Acute Respiratory Failure: A Secondary Analysis of the EFRAIM Study

Soraya Benguerfi et al. Respir Care. 2023 Jun.

Abstract

Background: Acute respiratory failure (ARF) remains the most frequent reason for ICU admission in patients who are immunocompromised. This study reports etiologies and outcomes of ARF in subjects with solid tumors.

Methods: This study was a post hoc analysis of the EFRAIM study, a prospective multinational cohort study that included 1611 subjects who were immunocompromised and with ARF admitted to the ICU. Subjects with solid tumors admitted to the ICU with ARF were included in the analysis.

Results: Among the subjects from the EFRAIM cohort, 529 subjects with solid tumors (32.8%) were included in the analysis. At ICU admission, the median (interquartile range) Sequential Organ Failure Assessment score was 5 (3-9). The types of solid tumor were mostly lung cancer (n = 111, 21%), breast cancer (n = 52, 9.8%), and digestive cancer (n = 47, 8.9%). A majority, 379 subjects (71.6%) were full code at ICU admission. The ARF was caused by bacterial or viral infection (n = 220, 41.6%), extrapulmonary sepsis (n = 62, 11.7%), or related to cancer or treatment toxicity (n = 83, 15.7%), or fungal infection (n = 23, 4.3%). For 63 subjects (11.9%), the ARF etiology remained unknown after an extensive diagnostic workup. The hospital mortality rate was 45.7% (n = 232/508). Hospital mortality was independently associated with chronic cardiac failure (odds ratio 1.78, 95% CI 1.09-2.92; P = .02), lung cancer (odds ratio 2.50, 95% CI 1.51-4.19; P < .001), day 1 Sequential Organ Failure Assessment score (odds ratio 1.97, 95% CI 1.32-2.96; P < .001). ARF etiologies other than infectious, related to cancer, or treatment toxicity were associated with better outcomes (odds ratio 0.32, 95% CI 0.16-0.61; P < .001).

Conclusions: Infectious diseases remained the most frequent cause of ARF in subjects with solid tumors admitted to the ICU. Hospital mortality was related to severity at ICU admission, previous comorbidities, and ARF etiologies related to non-malignant causes or pulmonary embolism. Lung tumor was also independently associated with higher mortality.

Keywords: ICU; critical care outcomes; lung neoplasms; medical oncology; neoplasms; respiratory insufficiency.

PubMed Disclaimer

Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Acute respiratory failure (ARF) etiology and outcome according to the type of tumors.
Fig. 2.
Fig. 2.
Proportion of diagnostic test according to the acute respiratory failure (ARF) etiology.
Fig. 3.
Fig. 3.
Crude mortality curve according to the acute respiratory failure (ARF) etiology.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Allemani C, Matsuda T, Di Carlo V, Harewood R, Matz M, Nikšić M, et al. ; CONCORD Working Group. Global surveillance of trends in cancer survival 2000–14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet 2018;391(10125):1023-1075. - PMC - PubMed
    1. Assoun S, Lemiale V, Azoulay E. Molecular targeted therapy-related life-threatening toxicity in patients with malignancies. A systematic review of published cases. Intensive Care Med 2019;45(7):988-997. - PMC - PubMed
    1. Borcoman E, Dupont A, Mariotte E, Doucet L, Joseph A, Chermak A, et al. . One-year survival in patients with solid tumours discharged alive from the intensive care unit after unplanned admission: a retrospective study. J Crit Care 2020;57:36-41. - PubMed
    1. Fisher R, Dangoisse C, Crichton S, Whiteley C, Camporota L, Beale R, Ostermann M. Short-term and medium-term survival of critically ill patients with solid tumours admitted to the intensive care unit: a retrospective analysis. BMJ Open 2016;6(10):e011363. - PMC - PubMed
    1. Torres VBL, Vassalo J, Silva UVA, Caruso P, Torelly AP, Silva E, et al. . Outcomes in critically ill patients with cancer-related complications. PLoS One 2016;11(10):e0164537. - PMC - PubMed