The Characteristics And Prognostic Factors Of Critically Mechanical Ventilation Patients With Cancer

Background and Objective:In recent years,with the increasing of the incidence of cancer,early screening and diagnosis and the advances in the treament,the survival rate of tumor patients was markedly increased.Cacer has become a chronic illness.And there are a large number of patients with cancer.With the increasing of patients,the advances in the treament and the complications of the cancer,they also lead to the need to be admitted to ICU.Therefore the number of severe cancer patients has been increasing.Studies have shown that the beds of cancer patients account for more than 15%in ICU,and cancer patients account for about 13.5%-21.5%in ICU.ICU treatment offers benefits to patients who potentially be reversed.The research suggests that compared to the non-cancer patients,the hospital mortality rate of tumor patients does not increase with comorbidities such as heart failure,liver failure,and respiratory failure.When deciding whether to transfer cancer patients to ICU,It is decide to consider the disease could potentially be reversed,rather than assessing the diagnosis and metastasis of cancer.Acute respiratory failure is the most common reasons for critically ill cancer patients to be transferred to ICU.Due to the population is immunocompromised,the mortality rate of critically ill tumor patients with acute respiratory failure being high,especially when invasive mechanical ventilation（IMV）being required,which can reach 50-70%.With the progress of mechanical ventilation management in recent years,it is of great significance to understand the characteristics of critically ill tumor patients with respiratory failure and identify the risk factors of death in such special populations,to optimize clinical management strategies,to improve diagnosis and treatment levels,and to improve the prognosis of critically ill cancer patients.However,there is still a lack of research on critically ill cancer patients who require mechanical ventilation treatment for acute respiratory failure in China.Therefore,this study aims to explore the characteristics and related risk factors affecting the prognosis of critically ill cancer patients with acute respiratory failure who require mechanical ventilation.Methods:This study retrospectively analyzed the data of 190 critically ill cancer patients who received mechanical ventilation due to acute respiratory failure at the Intensive Care Department of the The First Affiliated Hospital of Guangzhou Medical University from 2015 to 2022.The patients were divided into survival group and death group according to the outcome in 28 days of ICU.And Collect the datas of the patient’s age,gender,complications（including chronic obstructive pulmonary disease,diabetes,heart failure,renal failure,liver failure）,cancer related information（primary cancer,cancer stage,previous treatment,treatment types）,ICU SOFA score,non-respiratory SOFA score,APACHE II score,the initial oxygenation strategy for patients in the first day of ICU（including standard oxygen therapy,NIV,HFNO,IMV）,ventilation parameters（tidal volume,positive end expiratory pressure,peak pressure,ventilator mode）,whether to undergo CRRT treatment,whether to use ECMO,invasive mechanical ventilation duration,ICU duration,hospitalization duration,and patient laboratory indicators（including Lac,PCT,WBC,HB,PLT,Lyn,Pa CO2,Pa O2,FIO2,Cr）.In addition,collect the causes of respiratory failure in patients,and mainly classified into three types:pulmonary infections with cultured pathogens,pulmonary infections without cultured pathogens,and non-infectious.Then conduct univariate analysis and multivariate logistic regression analysis on the risk factors of critically ill cancer patients in the survival and death groups,and draw subject operating characteristic curves（ROCs）to explore the predictive value of relevant risk factors for the prognosis evaluation of mechanically ventilated critically ill tumor patients.Results:A total of 190 patients were included in this study,with 114（60%）patients in the survival group and 76（40%）patients in the death group.Among them,166（87.4%）patients were solid tumors and 24（12.6%）patients were hematological malignancies.Univariate analysis shows that compared with the survival group,the death group has higher APACHE II scores[23.00（19.00,29.00）vs 21.00（15.00,25.50）,P=0.004],higher non-respiratory SOFA score[7.00（4.00,9.00）vs 5.00（3.00,7.00）,P=0.002],shorter the stay of hospital[15.00（±12.00）vs 48.00（±35.00）,P<0.001],shorter the duration of ICU[10.00（±11.00）vs 25.00（±24.00）,P<0.001],shorter the duration of mechanical ventilation[9.82（±11.75）vs 33.51（±32.08）,P<0.001],lower PaO₂/FIO₂[58（45,92）vs 77（57,132）,P<0.019],and a higher proportion of respiratory etiology caused by non-infectious[11.00（14.50%）vs 3.00（2.60%）,P=0.008].Multivariate logistic regression analysis suggests that PaO₂/FiO₂[OR 0.467,95%CI 0.229-0.913,P=0.029],the stay of hospital[OR 0.896,95%CI 0.850-0.937,P<0.01],and respiratory etiology caused by non-infectious[OR 6.513,95%CI 1.280-44.235,P=0.035]are independent adverse risk factors affecting the prognosis.The area under the ROC curve of PaO₂/FiO₂for predicting prognosis is 0.651,sensitivity is 56.6%,and specificity is 74.6%;The area under the ROC curve for predicting prognosis based on the stay of hospital=0.881,sensitivity=86.8%,and specificity=74.6%;The area under the ROC curve for predicting prognosis of respiratory etiology caused by non-infectious is 0.567,sensitivity is 14.5%,and specificity is 97.4%.The area under the ROC curve for predicting the prognosis of severe tumor patients undergoing tracheal intubation by combining PaO₂/FiO₂,length of hospitalization,and respiratory etiology respiratory etiology caused by non-infectious is 0.909,sensitivity=75.0%,and specificity=68.9%.Conclusions:The results of this study suggest that PaO₂/FiO₂within 24 hours of admission to the ICU,the stay of hospital,and respiratory etiology caused by non-infectious are independent risk factors affecting the prognosis of severe tumor patients who require mechanical ventilation.