Prevalence and Risk Factors for Survival in Dogs and Cats With Cancer Admitted to the ICU.

Abstract

OBJECTIVE: To describe a population of dogs and cats with cancer admitted to the ICU and identify risk factors affecting survival. DESIGN: Prospective, observational cohort study between December 2022 and September 2023. SETTING: Veterinary referral teaching hospital. ANIMALS: Thirty-eight cats and 114 dogs. INTERVENTIONS: All ICU admissions were recorded. For patients with a confirmed or presumed cancer diagnosis, reason for ICU admission, clinicopathologic data, diagnostic imaging results, treatments, survival to discharge and at 90&#xa0;days postdischarge, and date of death, if applicable, were recorded. MEASUREMENTS AND MAIN RESULTS: The prevalence of ICU patients with cancer was 13.6% (165/1214 [95% confidence interval {CI}: 11.7-15.7]). A definitive diagnosis was obtained in 106 patients (73.7% [28/38] cats, 68.4% [78/114] dogs). Hematologic neoplasia was the most frequent cancer in cats (64.3% [18/28]), while carcinoma was the most frequent in dogs (37.2% [29/78]). The most frequent reasons for ICU admission were respiratory distress (31.6% [12/38] cats, 20.2% [24/114] dogs) and cardiovascular instability (21.1% [8/38] cats, 20.2% [23/114] dogs). Survival to discharge was 56.6% (44.7% [17/38] cats, 60.5% [69/114] dogs) and at 90&#xa0;days was 30.6% (21.1% [8/38] cats, 33.9% [37/109] dogs). In the multivariable Cox regression model, oncologic ICU admission was associated with increased hazard of death compared with nononcologic admission (hazard ratio [HR]: 6.06, 95% CI: 2.39-15.36; p&#xa0;<&#xa0;0.001); surgical treatment was associated with reduced hazard compared with medical treatment (HR: 0.21, 95% CI: 0.11-0.38; p&#xa0;<&#xa0;0.001); chemotherapy was associated with reduced hazard compared with no chemotherapy (HR: 0.40, 95% CI: 0.22-0.73; p&#xa0;=&#xa0;0.003); and normal albumin concentration in dogs was associated with reduced hazard compared with hypoalbuminemia (HR: 0.44, 95% CI: 0.26-0.72; p&#xa0;=&#xa0;0.004). CONCLUSIONS: Cancer was common in this ICU population (prevalence 13.6%). Mortality was high (69.4% 3&#xa0;months postdischarge), with 88% of deaths resulting from euthanasia.