Toward better mortality prediction in intensive care unit-admitted colorectal cancer patients

Colorectal cancer (CRC) remains a leading cause of cancer death worldwide. Dong et al evaluated prognostic factors associated with short-term outcomes among intensive care unit (ICU)-admitted CRC patients and highlighted the lack of a reliable prognostic tool despite commonly used ICU scores such as Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II. Their multicenter cohort (n = 189) reported a 90-day ICU mortality of 12.2%; however, modest sample size limits generalizability. Recent work links higher Sequential Organ Failure Assessment scores and emergency surgery to increased 90-day mortality in stage III disease. We argue that a robust prognostic model for this population should be multidimensional – incorporating frailty, cancer stage and treatment context (elective vs emergency surgery), comorbidities, nutritional and socioeconomic status, and timing/acuity of ICU transfer. Prospective, adequately powered studies are needed to develop and validate such tools to guide ICU triage and optimize outcomes for CRC patients. This manuscript call attention to the urgent need for validated, multidimensional prognostic models to guide ICU decision-making in CRC care.