Factors predicting 28-day and 90-day mortality in patients with solid organ cancer admitted to the intensive care unit who receive chemotherapy, targeted therapy, or a combination of chemotherapy and targeted therapy

Abstract Objective: Solid tumors are major causes of morbidity and mortality worldwide, and a substantial proportion of patients require intensive care during the course of illness. Despite advances in oncology and critical care, early mortality during and after ICU stay remains high in this population. We therefore aimed to evaluate the impact of the most recent oncologic treatment modality (chemotherapy, targeted therapy, or combination) on short- and intermediate-term mortality among ICU-admitted patients with solid organ malignancies. Materials and Methods: In this single-center, retrospective cohort, 1,422 cases were screened and 172 adult patients meeting inclusion criteria were analyzed. Clinical data and physiological/laboratory measurements at 0, 24, and 48 hours were recorded. The primary outcomes were 28-day and 90-day mortality. Results: Overall, 61% of the patients were male; the median follow-up was 90 days. ICU mortality was found to be 47.1%, 28-day mortality 50.6%, and 90-day mortality 64.5%. Patients receiving targeted therapy alone had the lowest 28- and 90-day mortality; the chemotherapy and combination arms were higher. At admission, a higher APACHE II score, need for mechanical ventilation and vasopressors, acute kidney injury, and positive cultures were associated with mortality. In Kaplan–Meier analysis, the estimated mean survival time was 59.8 days in the targeted-therapy arm, 37.6 days in the combination arm, and 34.1 days in the chemotherapy-alone arm (p=0.002). In multivariable Cox analysis, APACHE II score (HR=1.072; p=0.024) and the need for mechanical ventilation (MV) (HR=3.420; p=0.009) were independent predictors of mortality, whereas receipt of targeted therapy alone was found to be protective (HR=0.354; p=0.012). The chemotherapy-alone variable did not confer an independent risk. Culture positivity was significant in univariable analysis but lost significance in the multivariable model. Conclusion: Solid organ cancer patients admitted to the intensive care unit have outcomes that are influenced by both clinical scoring systems and the type of oncologic therapy received. The better short- to mid-term survival observed in patients treated with targeted therapies suggests that this subgroup may have more favorable ICU outcomes. Therefore, incorporating a patient's treatment history into risk stratification at the time of ICU admission can improve prognostic estimation and support clinical decision-making in the management of oncology patients in critical care. Keywords: intensive care unit, solid tumor, targeted therapy, mortality, APACHE II, sepsis, procalcitonin/albumin.