ORIGINAL PAPER

Who should be admitted to the intensive care unit? The outcomeof intensive care unit admission in stage IIIB–IV lung cancerpatients

Yu Jung Kim • Mi-Jung Kim • Young-Jae Cho • Jong Sun Park •

Jin Won Kim • Hyun Chang • Jeong-Ok Lee • Keun-Wook Lee • Jee Hyun Kim •

Ho Il Yoon • Soo-Mee Bang • Jae Ho Lee • Choon-Taek Lee • Jong Seok Lee

Received: 22 December 2013 / Accepted: 15 January 2014 / Published online: 22 January 2014

� Springer Science+Business Media New York 2014

Abstract Critical care for advanced lung cancer patients

is still controversial, and the appropriate method for the

selection of patients who may benefit from intensive care

unit (ICU) care is not clearly defined. We retrospectively

reviewed the medical records of stage IIIB–IV lung cancer

patients admitted to the medical ICU of a university hos-

pital in Korea between 2003 and 2011. Of 95 patients, 64

(67 %) had Eastern Cooperative Oncology Group (ECOG)

performance status (PS) C2, and 79 (84 %) had non-small-

cell lung cancer. In total, 28 patients (30 %) were newly

diagnosed or were receiving first-line treatment, and 22

(23 %) were refractory or bedridden. Mechanical ventila-

tion was required in 85 patients (90 %), and ICU mortality

and hospital mortality were 57 and 78 %, respectively.

According to a multivariate analysis, a PaO2/FiO2 ratio

\150 [odds ratio (OR) = 5.51, 95 % confidence interval

(CI) 2.10–14.48, p = 0.001] was independently associated

with ICU mortality, and an ECOG PS C2 (OR = 9.53,

95 % CI 2.03–44.85, p = 0.004) and a need for vasoactive

agents (OR = 6.94, 95 % CI 1.61–29.84, p = 0.009) were

independently associated with hospital mortality. Refrac-

tory or bedridden patients (n = 22) showed significantly

poorer overall survival (11.0 vs. 29.0 days, p = 0.005).

Among 21 patients who were discharged from the hospital,

11 (52 %) received further chemotherapy. Certain

advanced lung cancer patients may benefit from ICU

management. However, refractory patients and patients

with a poor PS do not seem to benefit from ICU care.

Oncologists should try to discuss palliative care and end-

of-life issues in advance to avoid futile care.

Keywords Advanced lung cancer � Intensive care unit �Outcome � Prognosis

Introduction

Lung cancer is the leading cause of cancer-related mor-

tality in Korea and worldwide [1, 2]. An estimated 20,711

new cases and 15,623 deaths from lung cancer were

identified in Korea in 2010 [1]. In addition to its poor

prognosis, lung cancer is also the most common solid

tumor that requires intensive care unit (ICU) management

[3]. ICU management of cancer patients has long been

controversial due to the uniformly high mortality rates

reported in early studies [4, 5]. However, recent advances

in critical care have improved survival in cancer patients

[3, 6], and the optimistic view that such improvements

might be applied to advanced lung cancer is spreading.

This view is based on small cohort studies that have

reported numerically improved survival rates for advanced

lung cancer patients admitted to the ICU [7–18]. However,

a recent study involving 49,373 patients with lung cancer

admitted to an ICU from the Surveillance, Epidemiology,

Yu Jung Kim and Mi-Jung Kim have contributed equally to this work.

Y. J. Kim � J. W. Kim � H. Chang � J.-O. Lee � K.-W. Lee �J. H. Kim � S.-M. Bang � J. S. Lee (&)

Divisions of Hematology and Medical Oncology, Department of

Internal Medicine, Seoul National University Bundang Hospital,

Seoul National University College of Medicine, 166 Gumi-ro,

Bundang-gu, Songnam-si, Gyeonggi-do 463-707, Republic of

Korea

e-mail: jslee0918@gmail.com

M.-J. Kim

National Cancer Center, Goyang-si, Republic of Korea

Y.-J. Cho � J. S. Park � H. I. Yoon � J. H. Lee � C.-T. Lee

Divisions of Pulmonology, Department of Internal Medicine,

Seoul National University Bundang Hospital, Seoul National

University College of Medicine, Songnam-si, Republic of Korea

123

Med Oncol (2014) 31:847

DOI 10.1007/s12032-014-0847-1

and End Results (SEER)-Medicare registry showed that

most patients die within 6 months of admission and that

ICU outcomes among patients with lung cancer did not

improve for patients diagnosed from 1992 to 2005 [19].

In the mean time, end-of-life ICU use among patients

with advanced lung cancer has been increasing over time

[20, 21]. ICU admission in the last 6 months of life

increased from 17.5 % in 1993 to 24.7 % in 2002 in the

United States according to the SEER-Medicare database

[20]. This finding is contrary to our expectations, because

increased hospice use in North America in the last decade

was expected to be associated with less aggressive cancer

care near the end of life. Furthermore, it has been reported

that patients with lung cancer who received early palliative

care had less aggressive care at the end of life, including

ICU care, but longer survival [22].

In this study, we analyzed the reasons for ICU admission

in advanced lung cancer patients, the clinical outcome, and

the factors related to mortality. We also evaluated how we

can identify patients who may not benefit from ICU care.

Patients and methods

Patients

We retrospectively reviewed the medical records of 95

patients with pathologically confirmed lung cancer who

were admitted to the medical ICU at Seoul National Uni-

versity Bundang Hospital between 2003 and 2011. The

patients had stage IIIB or IV non-small-cell lung cancer or

small-cell lung cancer with extensive disease. The protocol

was approved by the institutional review board of Seoul

National University Bundang Hospital.

Data collection

Demographic data, including age, sex, Eastern Cooperative

Oncology Group (ECOG) performance status (PS), histol-

ogy, stage, previous anticancer treatment, smoking history,

and co morbidities, were collected. Data on the treatments

at the ICU, such as mechanical ventilation (MV), hemod-

ialysis, and the use of a vasoactive agent, were also col-

lected. The Simplified Acute Physiology Score (SAPS) II

and the Acute Physiology and Chronic Health Evaluation

(APACHE) II score were calculated based on electronic

medical records. Organ failure was recorded if the patient

had respiratory failure (the presence of hypoxemia or

hypercapnia, clinical symptoms of respiratory distress, or a

need for MV), renal failure (serum creatinine[1.4 mg/dL,

creatinine clearance \60 mL/min, or a need for hemodi-

alysis), cardiovascular failure (a need for vasoactive

agents, the presence of congestive heart failure, or the

occurrence of ventricular tachycardia or fibrillation), neu-

rologic failure (Glasgow Coma Scale \10 or subjective

criteria, such as confusion, decreased responsiveness, or

coma), or hepatic failure (total bilirubin C2.0 mg/dL).

Sepsis was defined according to the criteria of the Ameri-

can College of Chest Physicians/Society of Critical Care

Medicine [23].

We attempted to categorize the reasons for ICU

admission according to the ‘criteria for ICU admission in

cancer patients’ by Azoulay E et al. [24, 25]. We defined

patients who were beyond third-line chemotherapy without

an objective response as refractory patients. We also

classified the reasons for ICU admission from an oncologic

perspective into four categories, after reviewing the med-

ical records of all patients. The first category was ‘cancer-

related events,’ which included obstructive pneumonia,

respiratory failure due to diffuse lung involvement of

cancer, cardiac tamponade, tumor bleeding, neurologic

events, and metabolic events. The second category was

‘treatment-related events,’ including radiation pneumoni-

tis, chemotherapy-induced lung toxicity, infection with

neutropenia, infection without neutropenia, and other

complications related to the treatment. This category

included patients who experienced events that had clear

relationship with the treatment. The third category was

‘infection, not clearly related to cancer or treatment,’

including pneumonia and other infection. Patients in this

category were those who did not receive chemotherapy

within 4 weeks, and those who did not have evidence of

disease progression. The last category was ‘Underlying

comorbidity-related events,’ including pulmonary disease

and cardiovascular disease.

Statistical analysis

Statistical analyses of categorical variables were performed

using Pearson’s v2 test or Fisher’s exact test. Continuous

variables were reported as the mean ± SD. Comparisons

of means between groups were performed using Student’s

t test. The median survival was calculated using the Kap-

lan–Meier method. Comparisons between different groups

were made using log-rank tests. A multivariate logistic

regression analysis was performed to identify independent

factors related to ICU or hospital mortality. Age, sex, and

variables with a p value \0.1 by univariate analysis were

included in the multivariate analysis. The multivariate

analysis was performed using the Cox proportional hazard

model to identify independent factors related to 90-day

mortality. In the case of collinear variables, only one var-

iable was chosen for the multivariate analysis. Two-sided

p values\0.05 were considered significant, and confidence

intervals (CIs) were calculated at a 95 % confidence level.

All statistical analyses were performed with IBM SPSS

847 Page 2 of 7 Med Oncol (2014) 31:847

123

Statistics for Windows, version 21.0 (IBM Corp., Armonk,

NY, USA).

Results

Patient characteristics

The mean age of the 95 patients was 65.6 years. Of these

patients, 17 (18 %) were female, and 64 (67 %) had an

ECOG PS C2. In total, 79 patients (84 %) had non-small-

cell lung cancer, and all patients were stage IV, except for

8 patients (8 %) with stage IIIB disease. Underlying

comorbidity was present in 63 patients (66 %), and 74

(80 %) were smokers. Before ICU admission, 89 patients

(94 %) had received radiotherapy or chemotherapy for

advanced lung cancer, and 80 (84 %) had received pallia-

tive chemotherapy, with a median of two treatment lines

(range 1–6). The median time interval from lung cancer

diagnosis to ICU admission was 198.0 days (range

3–1,512). Additionally, the median duration of the hospital

stay before admitting to the ICU was 4.0 days (range

0–57). Baseline patient characteristics are summarized in

Table 1.

Management at the ICU

The median duration of the ICU stay was 7.0 days (range

0–84). In total, 85 patients (90 %) required MV, 73 (77 %)

required vasoactive agents, and 13 (14 %) required he-

modialysis. Cardiopulmonary resuscitation (CPR) on

admission to the ICU was performed in 14 patients (15 %),

and the mean number of organ failures was 1.6 ± 1.0. On

the first day of ICU admission, the mean SAPS II score was

56.4 ± 18.0, and the mean APACHE II score was

24.1 ± 8.1. Patients’ status at the time of ICU admission

according to ICU survival is summarized in Table 2.

Reasons for ICU admission

According to the ‘criteria for ICU admission in cancer

patients’ by Azoulay E et al. [24, 25], 28 patients (30 %)

were newly diagnosed or were undergoing first-line che-

motherapy, 45 (47 %) were in an intermediate situation,

and 22 (23 %) were refractory or bedridden (Table 3). All

of the refractory or bedridden patients were ‘full code’ at

ICU admission, and none had discussed end-of-life issues,

including their ‘do not resuscitate (DNR)’ preferences,

with their oncologists prior to the event requiring ICU care.

The patients were divided into four groups according to

the reasons for ICU admission from an oncologic per-

spective (Table 3). In total, 28 patients (30 %) had expe-

rienced a cancer-related event, which included obstructive

pneumonia (n = 6), respiratory failure due to diffuse lung

involvement of cancer (n = 7), cardiac tamponade

(n = 4), tumor bleeding (n = 3), neurologic events

(n = 5), and metabolic events (n = 3). Treatment-related

events had developed in 43 patients (45 %) and included

radiation pneumonitis (n = 2), chemotherapy-induced lung

toxicity (n = 3), infection with neutropenia (n = 19),

infection without neutropenia (n = 14), and other com-

plications related to treatment (n = 5). The causes of

infection with or without neutropenia (n = 33) were

pneumonia in all patients, except for two who had neu-

tropenic septic shock without evidence of pneumonia.

Twenty patients (21 %) had infections that were not clearly

Table 1 Baseline characteristics

Variables All patients

(n = 95)

Age, mean 65.6 ± 10.3

Sex

Male 78 (82 %)

Female 17 (18 %)

ECOG PS

0–1 31 (33 %)

2–4 64 (67 %)

Histology

NSCLC 79 (84 %)

Adenocarcinoma 33

Squamous cell carcinoma 22

LCNEC 6

Poorly differentiated carcinoma 9

Other 10

SCLC 15 (16 %)

Stage

IIIB 8 (8 %)

IV 72 (76 %)

ED 15 (16 %)

Smoking history 74 (80 %)

Comorbidity

Cardiovascular disease

(excluding hypertension)

14 (15 %)

Pulmonary disease 41 (43 %)

Diabetes 25 (26 %)

Other 15 (16 %)

Previous treatment

Palliative chemotherapy 80 (84 %)

Palliative radiotherapy 31 (33 %)

Concurrent chemoradiation 11 (12 %)

ECOG Eastern Cooperative Oncology Group, ED extensive disease,

LCNEC large-cell neuroendocrine carcinoma, n number, NSCLC non-

small-cell lung cancer, PS performance status, SCLC small-cell lung

cancer

Med Oncol (2014) 31:847 Page 3 of 7 847

123

related to cancer or treatment, and pneumonia was the

cause of infection in 19 patients (95 %). Underlying

comorbidity-related events included pulmonary disease

(n = 2), and cardiovascular disease (n = 2).

As a whole, 83 patients (87 %) had acute respiratory

failure, and pneumonia was the most common cause of

respiratory failure (64/83 patients, 77 %). Additionally, 26

patients (27 %) had sepsis.

Outcome analysis

With a median follow-up of 20 days (range 0–396) after

ICU admission, the median overall survival was 22 days

Table 2 Patients’ status at the time of ICU admission

Variables All patients (n = 95) ICU survivors (n = 41) ICU non-survivors (n = 54) p

Uncontrolled cancer/PD 41 (43 %) 20 21 0.335

Refractory disease/bedridden 22 (23 %) 7 15 0.221

Number of organ failures 1.6 ± 1.0 1.4 ± 0.9 1.7 ± 1.0 0.114

Acute respiratory failure 83 (87 %) 31 52 0.003

Pneumonia 64 (67 %) 22 42 0.013

Sepsis 26 (27 %) 9 17 0.302

SAPS II 56.4 ± 18.0 51.8 ± 16.1 59.9 ± 18.6 0.025

APACHE II 24.1 ± 8.1 22.5 ± 7.7 25.3 ± 8.2 0.092

Mechanical ventilation 85 (90 %) 32 53 0.002

Vasoactive agent 73 (77 %) 26 47 0.007

CPR 14 (15 %) 6 8 0.980

Hemodialysis 13 (14 %) 3 10 0.094

PaO2/FiO2 179.1 ± 106.8 235.4 ± 121.8 137.4 ± 70.3 <0.001

Decreased mentality 32 (34 %) 15 17 0.602

Bold values indicate statistically significant (p value \ 0.05)

APACHE II acute physiology and chronic health evaluation II, CPR cardiopulmonary resuscitation, FiO2 fraction of inspired oxygen, ICU

intensive care unit, n number, PaO2 partial pressure of O2 in arterial blood, PD progressive disease, SAPS II simplified acute physiology score II,

SCLC small-cell lung cancer

Table 3 Reasons for ICU admission

Number of

patients

ICU

mortality

(%)

Hospital

mortality

(%)

According to the criteria for ICU admission of cancer patients

Newly diagnosed/first-

line treatment (full-

code management)

28/95 (30 %) 54 71

Intermediate situation

(propose an ICU trial)

45/95 (47 %) 53 76

Refractory disease/

bedridden (do not

recommend ICU)

22/95 (23 %) 68 91

Oncologic perspective

Cancer-related events 28/95 (30 %) 57 79

Treatment-related

events

43/95 (45 %) 61 74

Infection, not clearly

related to cancer or

treatment

20/95 (21 %) 60 85

Underlying

comorbidity-related

events

4/95 (4 %) 25 75

ICU intensive care unit

Table 4 Multivariate logistic regression analysis of factors associ-

ated with ICU mortality and hospital mortality

Reference group OR 95 % CI p

ICU mortality

Male 1.17 0.34–3.98 0.801

Age \75 years 2.28 0.55–9.41 0.255

PaO2/FiO2 C150 5.51 2.10–14.48 0.001

No vasoactive agent 2.68 0.87–8.30 0.087

No hemodialysis 1.69 0.37–7.68 0.494

Hospital mortality

Male 0.16 0.02–1.07 0.058

Age \75 years 6.71 0.39–114.80 0.189

ECOG PS 0–1 9.53 2.03–44.85 0.004

No radiotherapy 1.45 0.33–6.38 0.624

No pulmonary disease 0.22 0.04–1.07 0.061

No diabetes 4.64 0.83–26.01 0.081

PaO2/FiO2 C150 2.53 0.60–10.68 0.205

No vasoactive agent 6.94 1.61–29.84 0.009

Bold values indicate statistically significant (p value \ 0.05)

CI confidence interval, ECOG Eastern Cooperative Oncology Group,

FiO2 fraction of inspired oxygen, ICU intensive care unit, OR odds ratio,

PaO2 partial pressure of O2 in arterial blood, PS performance status

847 Page 4 of 7 Med Oncol (2014) 31:847

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(95 % CI 10.86–33.14). Thirteen patients (14 %) died

within 24 h after being admitted to the ICU. Overall, ICU

mortality was 57 %, and hospital mortality was 78 %. In

the multivariate logistic regression analysis, a PaO2/FiO2

ratio \150 [odds ratio (OR) = 5.51, 95 % CI 2.10–14.48,

p = 0.001] was independently associated with ICU mor-

tality, and an ECOG PS C2 (OR = 9.53, 95 % CI

2.03–44.85, p = 0.004) and a need for vasoactive agents

(OR = 6.94, 95 % CI 1.61–29.84, p = 0.009) were inde-

pendently associated with hospital mortality (Table 4).

The 3-month and 6-month mortality rates were 80 and

87 %, respectively. In the univariate analysis of factors

associated with 90-day mortality, an ECOG PS C2,

refractory disease, number of organ failures C3, a low

PaO2/FiO2 ratio, and a need for vasoactive agents were

statistically significant. In the multivariate analysis, an

ECOG PS C2 [hazard ratio (HR) = 2.21, 95 % CI

1.29–3.80, p = 0.004), refractory disease (HR = 2.18,

95 % CI 1.23–3.89, p = 0.008), and a PaO2/FiO2 ratio

\150 (HR = 1.97, 95 % CI 1.21–3.20, p = 0.006) were

independently associated with 90-day mortality (Table 5).

Refractory or bedridden patients (n = 22) showed signifi-

cantly poorer overall survival (11.0 vs. 29.0 days,

p = 0.005), and only two of these patients were discharged

from the hospital (Fig. 1).

Among 41 patients who were discharged from the ICU,

20 patients died before hospital discharge. Overall, the

median survival following ICU discharge was 56 days

(95 % CI 17.11–94.90; range 2–397). For the 21 patients

who were discharged from the hospital, the median sur-

vival following ICU discharge was 177 days (95 % CI

36.44–317.56; range 18–397). Eleven patients (11/21,

52 %) underwent further systemic chemotherapy after ICU

discharge, and these patients exhibited prolonged survival

after ICU discharge (253 vs. 93 days, p = 0.040).

Discussion

Although the management of critically ill cancer patients has

significantly improved, whether such management could be

applied to advanced lung cancer patients is still unclear.

Several studies have reported encouraging results regarding

ICU care for advanced lung cancer patients, with ICU mor-

tality rates ranging from 31 to 85 % and hospital mortality

rates ranging from 33 to 91 % [7–17] (Table 6). In our study,

the ICU mortality rate was 57 %, and the hospital mortality

rate was 78 %. These values may seem higher than the rates

reported in recent studies, but in our study, all patients had

stage IIIB or IV disease (stage IV, 92 %), and 90 % of the

patients received MV. The proportion of stage IV patients in

the above-mentioned studies was generally 40–60 %, and

the proportion of patients who received MV was as low as

14 %. We analyzed this highly selective patient group in an

attempt to strictly focus on advanced-stage lung cancer

patients receiving ICU care, who may often drive oncologists

and intensivists into difficult and agonizing clinical situa-

tions. Furthermore, because more than 40 % of patients are

stage IV at initial diagnosis, and given that the 5-year sur-

vival rate of lung cancer across all stages is only 15–20 %,

most patients with lung cancer may become candidates for

ICU care at an advanced stage [1, 26].

Azoulay E et al. [24, 25] have suggested criteria for the

recommendation of ICU care for cancer patients, and we

tried to classify our patients according to these criteria. The

authors recommended that newly diagnosed cancer patients

or patients receiving first-line treatment receive full-code

management but did not recommend ICU care for

Table 5 Multivariate analysis of factors associated with 90-day

mortality

Reference group Multivariate p

HR (95 % CI)

Male 0.88 (0.46–1.69) 0.701

Age \75 years 1.11 (0.59–2.11) 0.746

ECOG PS 0–1 2.21 (1.29–3.80) 0.004

Non-refractory 2.18 (1.23–3.89) 0.008

PaO2/FiO2 C150 1.97 (1.21–3.20) 0.006

No vasoactive agent 1.82 (1.00–3.34) 0.052

Bold values indicate statistically significant (p value \ 0.05)

CI confidence interval, ECOG Eastern Cooperative Oncology Group,

FiO2 fraction of inspired oxygen, HR hazard ratio, PaO2 partial

pressure of O2 in arterial blood, PS performance status

Fig. 1 Survival in refractory or bedridden patients

Med Oncol (2014) 31:847 Page 5 of 7 847

123

bedridden patients or patients with no further lifespan-

extending treatment. Finally, the authors recommended

proposing an ICU trial in patients with other situations or

situations in doubts. In our study, 30 % of the patients were

newly diagnosed or receiving first-line treatment, and 23 %

of the patients were refractory or bedridden. Although not

statistically significant, the refractory/bedridden patients

showed higher mortality rates (ICU mortality of 68 % and

hospital mortality of 91 %). These patients also showed

significantly poorer overall survival (11.0 vs. 29.0 days,

p = 0.005), and only two of these patients were discharged

from the hospital. Because there were no established cri-

teria for ICU management, a considerable number of

refractory/bedridden lung cancer patients chose ICU care

in our study. Notably, all of the patients (n = 22) were ‘full

code’ at ICU admission, and none had discussed about end-

of-life issues with their oncologists prior to the event

requiring ICU care. Half of these patients were receiving

‘late-line’ chemotherapy and were admitted to the ICU due

to a chemotherapy-related complication. The patients and

their families could not discuss ICU care sufficiently even

immediately before ICU admission due to the acute dete-

rioration of the patients’ condition. These patients might

not have chosen late-line chemotherapy or ICU care if they

had received early palliative care and had an opportunity to

discuss end-of-life issues in advance [22]. In one recent

study, the ICU admission rate of terminal cancer patients

decreased from 17 to 0 %, following the opening of a

dedicated palliative care unit [27]. Although it would be

ethically unacceptable to limit ICU admission, it might be

even more unethical not to provide a patient with the

opportunity to avoid non-beneficial treatment.

Predictors of poor outcome in previous studies included

a need for MV [7, 9, 10, 12, 13, 16, 28], cancer recurrence

or progression [10, 11, 13, 14, 28–30], a poor PS [8, 13, 14,

27, 30], the number of organ system failures [11, 12, 14],

and a need for vasoactive agents [12, 16]. Concordant with

previous studies, in our study, an ECOG PS C2

(OR = 9.53, 95 % CI 2.03–44.85, p = 0.004) and a need

for vasoactive agents (OR = 6.94, 95 % CI 1.61–29.84,

p = 0.009) were independently associated with hospital

mortality, and an ECOG PS C2 (HR = 2.21, 95 % CI

1.29–3.80, p = 0.004) and refractory disease (HR = 2.18,

95 % CI 1.23–3.89, p = 0.008) were associated with

90-day mortality. In fact, all of our patients can be included

in the category of ‘cancer recurrence or progression,’ but

among these patients, particularly those with refractory

disease showed a poorer prognosis. In addition, as all of the

patients were in an advanced stage of disease, and given

that 90 % of the patients received MV, disease stage and a

need for MV were not predictors of mortality in our study.

However, a PaO2/FiO2 ratio \150 was a significant pre-

dictor of ICU and 90-day mortality. A PaO2/FiO2 ratio

\150 is known to portend high mortality, regardless of the

cause of respiratory failure, and is a significant predictor of

a poor outcome in patients receiving MV for more than

24 h [30]. The results of the multivariate analysis in this

study support the potential futility of ICU care for

advanced cancer patients with refractory disease or a poor

PS.

In conclusion, the clinical outcome of ICU care for

advanced lung cancer patients was poor, particularly in

patients with refractory disease or a poor PS. To avoid non-

beneficial care, oncologists should try to discuss palliative

care and end-of-life issues early in the course of treatment.

Conflict of interest The authors have declared no conflict of

interest.

Table 6 Published literatures on ICU care for advanced lung cancer patients

Study Number of patients NSCLC (%) Stage IV (%) MV (%) ICU mortality (%) Hospital mortality (%)

Ewer et al. [7] 46 65 NR 100 85 91

Boussat et al. [8] 57 92 47 91 67 75

Lin et al. [9] 81 77 59 100 73 85

Reichner et al. [10] 47 83 53 49 43 60

Soares et al. [11] 143 83 NR (IIIB or IV 59 %) 70 42 59

Adam et al. [12] 139 69 40 49 22 40

Roques et al. [13] 105 83 NR (IIIB or IV 66 %) 41 43 54

Toffart et al. [14] 103 80 61 40 31 48

Bonomi et al. [15] 1,134 100 55 14 NR 33

Andrejak et al. [16] 76 65 59 75 47 65

Chou et al. [17] 70 NR NR (IIIB or IV 96 %) 100 NR 59

Current study 95 84 92 (IIIB or IV 100 %) 90 57 78

ICU intensive care unit, MV mechanical ventilation, NR not reported, NSCLC non-small-cell lung cancer

847 Page 6 of 7 Med Oncol (2014) 31:847

123

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