Is aggressive care worth it for patients with cancer complicated by pneumonia? Prognostic factors based on pulse oximetry, performance status, and percentage of lymphocytes—a retrospective chart review in a tertiary hospital

Background: Pneumonia in cancer patients is often problematic in deciding whether to admit and administer antibiotics or pursue a comfort care pathway that may avoid in-hospital death. Aim: to identify factors easily assessed at admission in Thailand’s healthcare context that could serve as prognostic factors for in-hospital death. Design: Using regression analysis to identify the prognostic factors from clinical factors collected at admission. The primary outcome was in-hospital death. Setting: /Participants: Data were collected from the electronic medical records of Chiang Mai University Hospital, Thailand, from 2016 to 2017. Data on adult patients with cancer who were admitted due to pneumonia were reviewed. Results: : In total, 245 patients were included, and 146 (59.59%) were male. The median age of the patients was 66 years (IQR: 57-75). A total of 72 (29.39%) patients died during admission. From multivariate logistic regression, prognostic factors for in-hospital death included Palliative Performance Scale ≤ 30 (OR: 8.468, 95%CI: 3.471-20.659), Palliative Performance Scale 40-50% (OR: 2.787, 95%CI: 1.337-5.810), percentage of lymphocyte ≤ 8.0% (OR: 2.101, 95%CI: 1.081-4.081), and pulse oximetry ≤ 90% (OR: 2.008, 95%CI: 1.041-3.873). Conclusions: : The in-hospital death rate of cancer patients admitted with pneumonia was approximately 30%. PPS 10-30%, PPS 40-50%, percentage of lymphocytes ≤ 8%, and oxygen saturation < 90% could be prognostic factors for in-hospital death. Further prospective studies are needed to investigate the usefulness of these factors.