Temporal trends in intensive care unit outcomes for lung cancer patients: A 15-year analysis of the MIMIC-IV database.

e20693 Background: Lung cancer care has been transformed over the past decade. Targeted therapies and immunotherapy have extended median survival from roughly 10 months to over 38 months-a remarkable achievement. But here's the question no one has answered: when these patients become critically ill and need the ICU, are they faring any better than they were 15 years ago? Methods: We analyzed 1,689 lung cancer patients admitted to the ICU using the MIMIC-IV database (2008–2022), dividing the cohort into three treatment eras: 2008–2012 (n = 570), 2013–2017 (n = 503), and 2018–2022 (n = 616). We tracked hospital mortality, ICU mortality, why patients were being admitted, what interventions they received, and where they went after discharge. Results: Despite everything that's changed in lung cancer treatment, hospital mortality held steady at about 21% across all three eras (20.2%, 21.7%, and 20.9%; p = 0.834). ICU mortality told the same story: 12.6%, 12.3%, and 12.5% (p = 0.989). What did change was striking. The patients arriving in the ICU looked completely different. Metastatic disease rose from 51% to 61%. The reasons for admission shifted dramatically in respiratory failure dropped from 26% to just 1%, while sepsis climbed from essentially zero to 19%, and cardiac complications surged from 4% to 42%. We also saw less mechanical ventilation (39% down to 32%) and more hospice discharges (6% up to 11%). Conclusions: The oncologic revolution hasn't reached the ICU. Mortality stayed flat at 21% because what kills critically ill patients isn't cancer biology but it's acute organ failure. Meanwhile, the newer therapies brought their own problems: myocarditis, immune-related sepsis, and other complications that created entirely new pathways to the ICU. Add in the fact that we're now admitting patients with more advanced disease, and the survival gains were effectively cancelled out. These numbers matter for the conversations we have with patients and families. When a lung cancer patient becomes critically ill, the prognosis today is essentially what it was in 2008 and that reality should inform goals-of-care discussions.