Evaluation of mortality prediction models for oncology patients in intensive care unit

Background: As advancements in diagnosis and treatment have improved, the incidence of cancer patients has risen, leading to a higher rate of admission to intensive care units (ICU). Establishing criteria for ICU admission among cancer patients with high mortality rates is crucial for optimizing the use of limited resources. This study aims to evaluate the mortality rates of cancer patients, and assess the effectiveness of scoring systems for cancer patients in ICU settings. Methods: A total of 593 ICU patients admitted between April 2023 and October 2023, were retrospectively analyzed. Prognosis prediction tools, including Acute Physiology and Chronic Health Evaluation-2 (APACHE-2), Simplified Acute Physiology Score-3 (SAPS-3), Sequential Organ Failure Assessment (SOFA) and (National Early Warning Score) NEWS scores, were evaluated. Data from 91 patients were statistically analyzed. Results: The overall ICU mortality-rate was 32%, while the mortality rate among cancer patients reached 59%. APACHE-2, SAPS-3, NEWS and SOFA scores were significantly higher in deceased patients (p < 0.05). SAPS-3 and SOFA mortality rates were notably elevated in deceased patients (p = 0.001), whereas the difference in APACHE-2 mortality rates was not statistically significant. Conclusions: Scoring systems such as APACHE-2 and SAPS-3 are vital tools for determining the prognosis of ICU patients. We found that SAPS-3 had higher discriminatory power in predicting 28-day mortality compared to APACHE-2, SOFA and NEWS scores (Area Under the ROC curve (AUROC) = 0.857). The use of scoring systems is essential for optimizing ICU management in cancer patients, ensuring rational use of ICU-beds. Therefore, ongoing research into prognostic scoring systems is necessary to improve care standards and ICU efficiency.

APACHE; Critical care; Simplified acute physiology score; Organ dysfunction scores; Medical oncology

[1] Quintairos A, Pilcher D, Salluh JIF. ICU scoring systems. Intensive Care Medicine. 2022; 49: 223–225.

[2] Sakr Y, Krauss C, Amaral ACKB, Réa-Neto A, Specht M, Reinhart K, et al. Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit. British Journal of Anaesthesia. 2008; 101: 798–803.

[3] Williams B. The national early warning score: from concept to NHS implementation. Clinical Medicine. 2022; 22: 499–505.

[4] Mattiuzzi C, Lippi G. Current cancer epidemiology. Journal of Epidemiology and Global Health. 2019; 9: 217–222.

[5] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[6] Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2024; 74: 229–263.

[7] Santucci C, Carioli G, Bertuccio P, Malvezzi M, Pastorino U, Boffetta P, et al. Progress in cancer mortality, incidence, and survival: a global overview. European Journal of Cancer Prevention. 2020; 29: 367–381.

[8] Vigneron C, Charpentier J, Valade S, Alexandre J, Chelabi S, Palmieri LJ, et al. Patterns of ICU admissions and outcomes in patients with solid malignancies over the revolution of cancer treatment. Annals of Intensive Care. 2021; 11: 182.

[9] Schellongowski P, Sperr WR, Wohlfarth P, Knoebl P, Rabitsch W, Watzke HH, et al. Critically ill patients with cancer: chances and limitations of intensive care medicine—a narrative review. ESMO Open. 2016; 1: e000018.

[10] Neves MBM, Neves YCS, Bomonetto JVB, Matos PPC, Giglio A Del, Cubero D de IG. Evaluation of factors predicting the benefit from systemic oncological treatment for severely ill hospitalized patients: a retrospective study. BMC Palliative Care. 2023; 22: 131.

[11] Bouch CD, Thompson JP. Severity scoring systems in the critically ill. Continuing Education in Anaesthesia Critical Care & Pain. 2008; 8: 181–185.

[12] Falcão ALE, Barros AG de A, Bezerra AAM, Ferreira NL, Logato CM, Silva FP, et al. The prognostic accuracy evaluation of SAPS 3, SOFA and APACHE II scores for mortality prediction in the surgical ICU: an external validation study and decision-making analysis. Annals of Intensive Care. 2019; 9: 18.

[13] Choi JY, Jang JH, Lim YS, Jang JY, Lee G, Yang HJ, et al. Performance on the APACHE II, SAPS II, SOFA and the OHCA score of post-cardiac arrest patients treated with therapeutic hypothermia. PLOS ONE. 2018; 13: e0196197.

[14] Rahmatinejad Z, Hoseini B, Rahmatinejad F, Abu-Hanna A, Bergquist R, Pourmand A, et al. Internal validation of the predictive performance of models based on three ED and ICU scoring systems to predict inhospital mortality for intensive care patients referred from the emergency department. BioMed Research International. 2022; 2022: 3964063.

[15] Yuan ZN, Xue YJ, Wang HJ, Qu SN, Huang CL, Wang H, et al. A nomogram for predicting hospital mortality of critical ill patients with sepsis and cancer: a retrospective cohort study based on MIMIC-IV and eICU-CRD. BMJ Open. 2023; 13: e072112.

[16] Caruso P, Testa RS, Freitas ICL, Praça APA, Okamoto VN, Santana PV, et al. Cancer-related characteristics associated with invasive mechanical ventilation or in-hospital mortality in patients with COVID-19 admitted to ICU: a cohort multicenter study. Frontiers in Oncology. 2021; 11: 746431.

[17] Cárdenas-Turanzas M, Ensor J, Wakefield C, Zhang K, Wallace SK, Price KJ, et al. Cross-validation of a sequential organ failure assessment score-based model to predict mortality in patients with cancer admitted to the intensive care unit. Journal of Critical Care. 2012; 27: 673–680.

[18] Soares M, Fontes F, Dantas J, Gadelha D, Cariello P, Nardes F, et al. Performance of six severity-of-illness scores in cancer patients requiring admission to the intensive care unit: a prospective observational study. Critical Care. 2004; 8: R194–R203.

[19] Schnell D, Mayaux J, Lambert J, Roux A, Moreau AS, Zafrani L, et al. Clinical assessment for identifying causes of acute respiratory failure in cancer patients. European Respiratory Journal. 2013; 42: 435–443.

[20] Vallet H, Schwarz GL, Flaatten H, De Lange DW, Guidet B, Dechartres A. Mortality of older patients admitted to an ICU: a systematic review. Critical Care Medicine. 2021; 49: 324–334.

[21] Nazer LH, Lopez-Olivo MA, Brown AR, Cuenca JA, Sirimaturos M, Habash K, et al. A systematic review and meta-analysis evaluating geographical variation in outcomes of cancer patients treated in ICUs. Critical Care Explorations. 2022; 4: e0757.

[22] Martos-Benítez FD, Soler-Morejón C de D, Lara-Ponce KX, Orama-Requejo V, Burgos-Aragüez D, Larrondo-Muguercia H, et al. Critically ill patients with cancer: a clinical perspective. World Journal of Clinical Oncology. 2020; 11: 809–835.

[23] Vassallo M, Michelangeli C, Fabre R, Manni S, Genillier PL, Weiss N, et al. Procalcitonin and C-reactive protein/procalcitonin ratio as markers of infection in patients with solid tumors. Frontiers in Medicine. 2021; 8: 627967.

[24] Liengswangwong W, Siriwannabhorn R, Leela-Amornsin S, Yuksen C, Sanguanwit P, Duangsri C, et al. Comparison of Modified Early Warning Score (MEWS), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) for early prediction of septic shock in diabetic patients in Emergency Departments. BMC Emergency Medicine. 2024; 24: 161.

[25] Ghazaly HF, Alsaied A, Aly A, Sayed MH, Hassan MM. APACHE IV, SAPS III, and SOFA scores for outcome prediction in a surgical/trauma critical care unit: an analytical cross-sectional study. Ain-Shams Journal of Anesthesiology. 2023; 15: 101.

[26] Kiehl MG, Beutel G, Böll B, Buchheidt D, Forkert R, Fuhrmann V, et al. Consensus statement for cancer patients requiring intensive care support. Annals of Hematology. 2018; 97: 1271–1282.

[27] Zhu Y, Zhang R, Ye X, Liu H, Wei J. SAPS III is superior to SOFA for predicting 28-day mortality in sepsis patients based on Sepsis 3.0 criteria. International Journal of Infectious Diseases. 2022; 114: 135–141.

[28] Soares M, Salluh JIF. Validation of the SAPS 3 admission prognostic model in patients with cancer in need of intensive care. Intensive Care Medicine. 2006; 32: 1839–1844.