Investigation of the causes of morbidity and mortality among critically ill cancer patients who were admitted to the medical intensive care unit

The aim of study was to examine in detail the causes of morbidity and mortality in critically ill cancer patients hospitalized in the internal intensive care unit. This retrospective study was conducted on patients with hematological and oncological diagnoses who were followed and treated in the Internal Medicine Intensive Care Unit (ICU) of our hospital between January 1, 2015 and October 31, 2023. A total of 205 patients diagnosed with malignancy were included in the study. The ages of the patients ranged between 25-102 years with a mean age of 70.58±13.40 years. Of the patients included in the study, 66.8% were male and 33.2% were female. 76 (37.1%) pneumonia, 42 (20.5%) postoperative follow-up, 33 (16%) septicemia, 12 (5.8%) acute kidney injury, 11 (5.4%) febrile neutropenia, 7 (3.4%) gastrointestinal bleeding, 6 (2.9%) cerebrovascular events, 3 (1.5%) tumor lysis syndrome, 3 (1.5%) myocardial infarction, 2 (1%) decompensated heart failure, 2 (1.0%) status epilepticus and 8 (3.9%) other diagnoses (containing one patient each: vena cava superior syndrome, disseminated intravascular coagulation, pulmonary embolism, hemoptysis, ARDS, chronic obstructive pulmonary disease attack, immune effector cell-related neurotoxicity syndrome, diabetic ketoacidosis). As a result of our study, it was found that the mortality rate (37.1%) of patients admitted to the ICU with the diagnosis of pneumonia hospitalization was significantly higher compared to other hospitalization diagnoses (p<0.001). As a result of our study, progressive oncologic patients (40.9%) had a higher mortality rate in the ICU and this was statistically significant (p<0.05). It was determined that the mortality rate in patients with metastasis at the time of admission to the ICU was 55.3%, and the mortality rate in patients without metastasis was lower (44.7%), and this was statistically significant (p = 0.033). The rate of invasive mechanical ventilation was significantly higher in cancer patients who died in the ICU (87.9%) compared to those who did not die (20.5%) (p<0.001). In deceased oncologic patients, the baseline APACHE II score (deceased 35.32±8.63, living 18.24±8.32 p<0.001) and SOFA calculated on the day of hospitalization (deceased 10.87±3, 64, living 4.53±3.35, p<0.001) and admission GCS (deceased 7.72±3.96, living 13.21±2.84, p<0.001) scores were significantly higher compared to living patients. As a result of our study, there was no significant correlation between discharge status from the ICU and the presence of neutropenia and whether or not G-CSF treatment was received during hospitalization (p=0.778 for neutropenia; p=0.965 for G-CSF). The rate of vasopressor use in deceased critically ill cancer patients (88.6%) was significantly higher than in living patients (20.5%) (p<0.001). There was no significant correlation between the development of ARDS and discharge from the ICU (p=0,557). The discharge rate was significantly higher among critically ill cancer patients who did not develop acute kidney injury (80.8%) compared to patients who developed acute kidney injury (19.2%) (p<0.001). Leukocyte, neutrophil, urea, creatinine, aspartate aminotransferase, c-reactive protein, lactate dehydrogenase and lactate levels on the day of hospitalization were significantly higher, while hemoglobin, platelet, albumin, blood pH and PaO2/FiO2 values were significantly lower in oncologic patients who died in the ICU compared to those who were discharged.