Acute neurological dysfunction in critically ill patients with solid tumors: A 14-year retrospective study

Over recent decades, advancements in cancer therapies have led to improved survival, resulting in a growing number of cancer patients admitted to the intensive care unit (ICU). While respiratory and hemodynamic failures have been extensively studied, less attention has been given to acute neurological dysfunction (ND) in oncology patients.

This single-center retrospective study (2007-2020) aimed to assess the characteristics and outcomes of solid tumor patients admitted to the ICU for acute ND, distributed into cancer-related, oncology treatment-related, and non-specific causes.

1845 patients with solid tumor were admitted to the ICU, including 164 (8.9%) for acute ND. Lung (21%), urinary tract (21%) and digestive tract (20%) were the main tumor sites with mostly metastatic disease (58%). Main causes of admission were seizures with or without status epilepticus (33%), coma (27%), and delirium (27%). ND was predominantly cancer-related (36%) or due to independent complications (56%), while 8% had treatment-related ND. Coma, motor deficit, and a shorter time from symptoms onset to admission were more frequent in cancer-related ND patients. Most patients with treatment-related ND had normal brain imaging (67%) with signs of encephalopathy on electroencephalogram (86%). ICU mortality rate was 18%, with coma at admission being the only significant predictor of mortality (OR 5.96 [2.06-20.4]).

One in ten cancer patients admitted to the ICU presents with acute ND. Among them, one-third are ultimately diagnosed with cancer-related ND, characterized by a short time from symptoms onset to ICU admission and the presence of coma or motor deficit at ICU admission. This condition does not negatively impact ICU survival.