The Intensive care outcome of patients with a solid tumor in a tertiary care hospital in Saudi Arabia: Results of a prospective ICU Registry

Main Article Content

Asiah Salem Rugaan
Naved Hasan
Masood Iqbal
Elaf Damanhouri
Rwan Emad Radi
Enshrah Radwan
Maher Alhazmi


Objective: There is a paucity of research on the factors predicting mortality and a length of stay in the Intensive Care Unit (ICU) with solid tumor patients. This study will assess the characteristics and predictors of outcomes of patients with solid tumors in medical ICU.

Material and Methods: This research has been designed as a retrospective observational study using an ICU database. Patients who have a solid tumor were included in the study (May 2015 to July 2018). Post-surgical and those with a length of stay of more than one day are excluded from the study. We identified the predictors     for ICU mortality and ICU long stay (≥21 days).

Results: Out of 2883 patients, 364 patients with solid tumors were enrolled. The commonest sites for solid tumors were breast (15.9%), colorectal (11.5%), and lung (9.9%). 158 (43.4%) had metastatic disease, and 264 (72.5%) with progressive disease. The major reasons for ICU admission were a respiratory failure (52.7%) and severe sepsis (52.2%). The ICU and hospital mortality rates were 32.4% and 47%, respectively. Fifty patients (13.7%) had long stayed (≥ 21 days) in ICU. The independent predictors for mortality were Sequential Organ Failure Assessment (SOFA) score (OR, 1.2; 95% CI, 1.1–1.3; P=.000), invasive ventilation (OR, 3.5; 95% CI, 1.5–8.3; P=.004) and vasopressor (OR, 2.6; 95% CI, 1.1–5.9; P=.018), while the independent predictors of long-stay were ICU infections (odds ratio [OR], 18.9; 95% CI, 5.3 – 66.7; P=.0001), SOFA score (OR, 1.5; 95% CI, 1.2–1.8; P=.0001), invasive ventilation (OR, 8.2; 95% CI, 1.6–40.4; P=.009), bilirubin (OR, .5; 95% CI .2–.9; P=.049).

Conclusion: Irrespective of the cancer stage, patients had a reasonable survival, and most do not require a long stay in the ICU. Flexibility in admission should be considered as disease progression and metastatic disease were not independent predictors of ICU mortality or long stay in this study.


Download data is not yet available.

Article Details

How to Cite
Rugaan, A. S. ., Hasan, N., Iqbal, M. ., Damanhouri, E. ., Radi, R. E. ., Radwan, E. ., & Alhazmi, M. . (2021). The Intensive care outcome of patients with a solid tumor in a tertiary care hospital in Saudi Arabia: Results of a prospective ICU Registry. Medical Science and Discovery, 8(10), 608–618.
Research Article
Received 2021-10-08
Accepted 2021-10-17
Published 2021-10-18


Ñamendys-Silva, S. A., Texcocano-Becerra, J., & Herrera-Gómez, A. (2010). Prognostic Factors in Critically Ill Patients with Solid Tumours Admitted to an Oncological Intensive Care Unit. Anaesthesia and Intensive Care, 38(2), 317–324.

Azoulay E, Soares M, Darmon M, Benoit D, Pastores S, Afessa B. Intensive care of the cancer patient: recent achievements and remaining challenges. Ann Intensive Care. 2011; 1(1):5.

Staudinger T, Stoiser B, Müllner M, Locker GJ, Laczika K, Knapp S, et al. Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 2000; 28(5):1322–8.

Mokart D, Etienne A, Esterni B, Brun JP, Chow-Chine L, Sannini A, et al. Critically ill cancer patients in the intensive care unit: short-term outcome and 1-year mortality. Acta Anaesthesiol Scand 2012; 56:178–89.5.

Azoulay E, Afessa B. The intensive care support of patients with malignancy: do

everything that can be done. Intensive Care Med 2006; 32:3–5.

Taccone FS, Artigas AA, Sprung CL, Moreno R, Sakr Y, Sakr Y, Vincent JL, et al. Characteristics and outcomes of cancer patients in European ICUs. Crit Care

2009; 13(1): R15.

Gulbin Aygencel, Melda Turkoglu, Gulsan Turkoz Sucak, Mustafa Benekli, Prognostic factors in critically ill cancer patients admitted to the intensive care unit, Journal of Critical Care, Volume 29, Issue 4,2014, Pages 618-626.

Gulbin Aygencel, Melda Turkoglu, Characteristics, Outcomes and Costs of Prolonged Stay ICU Patients Journal of Medical and Surgical Intensive Care Medicine, 2(3):53-58, 12, 2011

Márcio Soares, Jorge I.F. Salluh, Viviane B.L. Torres, Juliana V.R. Leal, Nelson Spector, Short- and Long-term Outcomes of Critically Ill Patients With Cancer and Prolonged ICU Length of Stay, Chest, Volume 134, Issue 3, 2008, Pages 520-526

Yaseen Arabi, S. Venkatesh, Samir Haddad, Abdullah Al Shimemeri, Salim Al Malik, A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization, International Journal for Quality in Health Care, Volume 14, Issue 5, October 2002, Pages 403–410,

Azoulay, E., Moreau, D., Alberti, C. et al. Predictors of short term mortality in critically ill patients with solid malignancies. Intensive Care Med (2000) 26: 1817-1823(2000)

Xia, R., Wang, D. Intensive care unit prognostics factors in critically ill patients with advanced solid tumors: a 3-year retrospective study, BMC Cancer, (2016).

Kingah, P., Alzubaidi, N., Yafawi, J., Shehada, E., Alshabani, K., & Soubani, Factors Associated with Mortality in Patients with a Solid Malignancy Admitted to the Intensive Care Unit - A Prospective Observational Study. Journal of critical care medicine (Universitatea de Medicina si Farmacie din Targu-Mures), 4(4), 2018, 137–142. doi:10.2478/jccm-2018-0019

Benekli, M. (2017). Challenging decision: ICU admission of critically ill elderly solid tumor patients. Journal of Thoracic Disease, 9(10), 3564-3567. doi:10.21037/jtd.2017.09.25

McGrath S, Chatterjee F, Whiteley C, Ostermann M, ICU and 6-month outcome of oncology patients in the intensive care unit, QJM: An International Journal of Medicine; 2010 103(6): 397–403.

Darmon M, Azoulay E. Critical care management of cancer patients: cause for optimism and need for objectivity. Curr Opin Oncol 2009; 21:318–26.

Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB. Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 1999; 160: 1957-61.

Rady, M. Y., & Johnson, D. J. (2004). Admission to intensive care unit at the end-of-life: is it an informed decision? Palliative Medicine, 18(8), 705–711.

Yeo CD, Kim JW, Kim SC, Kim YK, Kim KH, et al. Prognostic factors in critically ill patients with hematologic malignancies admitted to the intensive care unit. J Crit care 2012; 27(6):739.e1-739.e6.

María Lucía Pérez Pérez, Ana Gonzaga López, Bárbara Balandín Moreno, Constanza Maximiano Alonso Characteristics and outcome of patients with solid tumour requiring admission to the intensive care unit. Usefulness of three severity score systems, Medicina Clínica, Volume 153, Issue 7, 11 October 2019, Pages 270-275

Soares M, Salluh JI, Spector N, Rocco JR. Characteristics and outcomes of cancer patients requiring mechanical ventilatory support for N24 hrs. Crit Care Med 2005; 3:520–6.

Lamia B, Hellot MF, Girault C, Tamion F, Dachraoui F, Lenain P, et al. Changes in severity and organ failure scores as prognostic factors in onco-hematological malignancy patients admitted to the ICU. Intensive Care Med 2006; 32(10):1560–8.

Sculier, Jean-Paul MD, Ph.D; Paesmans, Marianne MSc; Markiewicz, Eveline RN; Berghmans, Thierry MD Scoring systems in cancer patients admitted for an acute complication in a medical intensive care unit, Critical Care Medicine: August 2000 - Volume 28 - Issue 8 - p 2786-2792

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. Crit Care 2004; 8: R194–203.

Schellongowski P, Benesch M, Lang T, Traunmuller F, Zauner C, Laczika K, et al. Comparison of three severity scores for critically ill cancer patients. Intensive Care Med 2004; 30:430–6.

Higgins TL, McGee WT, Steingrub JS, et al. Early indicators of prolonged intensive care unit stay: impact of illness severity, physician staffing, and pre-intensive care unit length of stay. Crit Care Med 2003; 31:45-51

E´lie Azoulay, Thiéry, Guillaume MD; Chevret, Sylvie MD, Ph.D; Moreau, Delphine MD; Darmon, Michaël MD; The Prognosis of Acute Respiratory Failure in Critically Ill Cancer Patients, Medicine 2004; 83(6):360–370. Doi 10.1097/

Martos-Benítez, F.D., Soto-García, A. & Gutiérrez-Noyola, A. Clinical characteristics and outcomes of cancer patients requiring intensive care unit admission: a prospective study. J Cancer Res Clin Oncol 144, 717–723 (2018).

Lecuyer, Lucien MD; Chevret, Sylvie MD, Ph.D; Thiery, Guillaume MD; Darmon, Michael MD; Schlemmer, Benoît MD; Azoulay, Élie MD, Ph.D The ICU Trial: A new admission policy for cancer patients requiring mechanical ventilation*, Critical Care Medicine: March 2007 - Volume 35 - Issue 3 - p 808-814 doi: 10.1097/01.CCM.0000256846.27192.7A

Kollef, Marin H. MD; Shapiro, Steven D. MD; Silver, Patricia MEd; St. John, Robert E. MSN; Prentice, Donna MSN; Sauer, Sharon BSN; Ahrens, Tom S. DNS; Shannon, William PhD; A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 1997; 25 (4) :576-574

Gregory P. Marelich, Susan Murin, Felix Battistella, John Inciardi, Terry Vierra, Marc Roby, Protocol Weaning of Mechanical Ventilation in Medical and Surgical Patients by Respiratory Care Practitioners and Nurses: Effect on Weaning Time and Incidence of Ventilator-Associated Pneumonia, Chest, Volume 118, Issue 2, 2000, Pages 459-467,

Wood G, MacLeod B, Moffatt S. Weaning from mechanical ventilation: physician-directed vs a respiratory-therapist-directed protocol. Respir Care. 1995 Mar; 40(3) 219-224. PMID: 10141679.

Martin CM, Hill AD, Bums K, et al. Characteristics and outcomes for critically ill patients with prolonged intensive care unit stays. Crit Care Med 2005; 33:1922-1927

Laupland KB, Kirkpatrick AW, Kortbeek JB, et al. Long-term mortality outcome associated with prolonged admission to the ICU. Chest 2006; 129:954-959

Moran JL, Solomon PJ, Williams PJ. Assessment of outcome over a 10-year period of patients admitted to a multidisciplinary adult intensive care unit with haematological and solid tumors. Anaesth Intensive Care 2005; 33:26

Soares M, Caruso P, Silva E, Teles JM, Lobo SM, Brazilian Research in Intensive Care Network (BRICNet), Friedman G, et al. Characteristics and outcomes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med 2010; 38(1):9–15.

Mokart D, Lambert J, Schnell D, Fouche L, Rabbat A, Kouatchet A, et al. Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure. Leuk Lymphoma 2013; 54(8):1724–9.

Chih-Chia Hsieh, Ching-Chi Lee, Hsiang-Chin Hsu, Hsin-I Shih, Chien-Hsin Lu, Chih-Hao Lin, Impact of delayed admission to intensive care units on patients with acute respiratory failure, American Journal of Emergency Medicine, volume 35, issue1, January 2017, Pages 39-44.