Abstract
OBJECTIVE: To determine whether admission to critical care is associated with subsequent disease progression in patients with non-metastatic solid tumors. METHODS: This observational cohort study of UK Biobank participants identified those diagnosed with solid tumors and survived hospitalization. Two cohorts were identified based on critical care admission and new metastatic disease as reported at UK Biobank follow-up visits, or primary or secondary care records were compared. Cox proportional hazards analysis was used to account for potential confounders in the multivariate analysis. RESULTS: A total of 1,854 solid tumor patients were identified, of whom 453 (24.4%) experienced critical care admission. Unadjusted rates of metastatic disease and death were higher for the critical care cohort with lower progression-free survival. At five years, 25% of the critical care survivors and 14% of the hospitalized survivors had developed metastatic disease (p < 0.001), with a corresponding progression-free survival rate of 65% versus 81% (p < 0.001). After adjustment for confounders, the hazard ratio for progression-free survival between critical care survivors and the hospitalized cohort was 1.69 (95%CIs 1.31 - 2.18; p < 0.001). CONCLUSION: Solid tumor patients admitted to the hospital within 2 years of diagnosis had poorer subsequent progression-free survival if they had experienced a critical care admission. This observation was maintained after adjustment for confounding variables.