Predictors of in-hospital mortality among critically ill patients in ICU with cancer: A retrospective MIMIC-IV cohort analysis.

Abstract

e23111 Background: Critically ill patients with cancer admitted to the intensive care unit (ICU) remain at high risk for adverse outcomes. Identifying early predictors of mortality could greatly improve risk stratification and clinical strategies. The goal of this study was to pinpoint correlations between various factors and in-hospital mortality among adult cancer patients admitted to the ICU. Methods: The research utilized the MIMIC-IV (v3.1) database in a retrospective cohort study design. The study population encompassed adult patients with a malignancy diagnosis who were admitted to the ICU between 2008 and 2019. Malignancy diagnoses were determined using ICD-9 and ICD-10 codes, focusing exclusively on each patient's initial ICU admission. Researchers extracted demographic data, comorbidity information, initial vital signs, laboratory results, SOFA scores, and Charlson Comorbidity Index (CCI) values. The primary outcome measured was in-hospital mortality. Multivariable logistic regression models, adjusted for 13 clinical and demographic factors, were developed to identify independent predictors, with model performance assessed using AUROC. Results: A total of 10,321 patients were included (mean age 66.4 ± 13.4 years; 58.3% male). Overall, in-hospital mortality was 20.2%. Non-survivors were older and had higher SOFA scores (7.5 vs 3.8, p < 0.001) and CCI (8.7 vs 7.7, p < 0.001). In the multivariable model, higher SOFA score (OR 2.68, 95% CI 2.50-2.88), Charlson Index (OR 1.46, 95% CI 1.36-1.57), and heart rate (OR 1.733, 95% CI 1.63-1.83) were independently associated with increased mortality, while higher MAP and Spo2 were protective. The model demonstrated good discrimination (AUROC 0.82). Conclusions: For critically ill cancer patients, the severity of their illness and the burden of comorbidities are the most significant predictors of in-hospital mortality. Early physiological parameters might provide a valuable tool for timely prognostication and aid in clinical decision-making. Clinical predictors of in-hospital mortality in critically Ill cancer patients. Predictor Variable Survivors (N = 8,240) Non-Survivors (N = 2,081) Adjusted Odds Ratio (95% CI) P-value Age, mean ± SD (years) 66.0 ± 13.5 68.2 ± 13.1 1.04 (1.00–1.07) <0.001 SOFA score, mean ± SD 3.8 ± 2.9 7.5 ± 4.2 2.68 (2.50–2.88) <0.001 Charlson Comorbidity Index 7.7 ± 3.0 8.7 ± 2.8 1.46 (1.36–1.57) <0.001 Heart rate (per unit increase) — — 1.73 (1.63–1.83) <0.001 Mean arterial pressure (MAP) — — 0.83 (0.78–0.89) <0.001 SpO₂ (per unit increase) — — 0.65 (0.61–0.69) <0.001 Platelet count — — 1.13 (1.07–1.20) <0.001 White blood cell count — — 1.09 (1.04–1.14) <0.001 Creatinine — — 0.91 (0.86–0.97) 0.003 Abbreviations: CI: Confidence Interval, MAP: Mean Arterial Pressure, OR: Odds Ratio, SOFA: Sequential Organ Failure Assessment, SpO₂: Peripheral Oxygen Saturation.