Assessment of Functional and Nutritional Status and Skeletal Muscle Mass for the Prognosis of Critically Ill Solid Cancer Patients

SIMPLE SUMMARY: Critically ill cancer patients requiring intensive care unit (ICU) admission remain affected by high mortality rates. We wanted to evaluate how their ability to perform daily activities, their nutritional status, and muscle surface can impact their prognosis. Muscle surface was determined through automatic analysis of computed tomography scans using a deep learning-based technique. We found that most cancer patients displayed low muscular surface upon ICU admission, and that muscle surface, the ability to perform daily activities, and the six month course of nutritional parameters were able to predict short- and long-term prognosis. ABSTRACT: Simple and accessible prognostic factors are paramount for solid cancer patients experiencing life-threatening complications. The aim of this study is to appraise the impact of functional and nutritional status and skeletal muscle mass in this population. We conducted a retrospective (2007–2020) single-center study by enrolling adult patients with solid cancers requiring unplanned ICU admission. Performance status, body weight, and albumin level were collected at ICU admission and over six months. Skeletal muscle mass was assessed at ICU admission by measuring muscle areas normalized by height (SMI). Four-hundred and sixty-two patients were analyzed, mainly with gastro-intestinal (34.8%) and lung (29.9%) neoplasms. Moreover, 92.8% of men and 67.3% of women were deemed cachectic. In the multivariate analysis, performance status at ICU admission (CSH 1.74 [1.27–2.39], p < 0.001) and the six month increase in albumin level (CSH 0.38 [0.16–0.87], p = 0.02) were independent predictors of ICU mortality. In the subgroup of mechanically ventilated patients, the psoas SMI was independently associated with ICU mortality (CSH 0.82 [0.67–0.98], p = 0.04). Among the 368 ICU-survivors, the performance status at ICU admission (CSH 1.34 [1.14–1.59], p < 0.001) and the six-month weight loss (CSH 1.33 [1.17–2.99], p = 0.01) were associated with a one-year mortality rate. Most cancer patients displayed cachexia at ICU admission. Time courses of nutritional parameters may aid the prediction of short- and long-term outcomes.