ArticleLiver international : official journal of the International Association for the Study of the Liver2025
Breaking Barriers for Intensive Care Admission in Patients With Advanced HCC on Immunotherapy.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Critical complications in cancer patients admitted to the ICU in the era of immunotherapy: recognition, differential diagnosis, and management.Frontiers in medicine · 2026Review
- Development and external validation of an interpretable deep learning model for early immune-related adverse events in hepatocellular carcinoma.Frontiers in immunology · 2026Article
- When and for Whom Does Intensive Care Unit Admission Change the Prognosis in Oncology?-A Scoping Review.Cancers · 2025Review
- Breaking Barriers for Intensive Care Admission in Patients With Advanced HCC on Immunotherapy.Liver international : official journal of the International Association for the Study of the Liver · 2025Article
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Authors and funding
29 authors.
Funding
Abstract
BACKGROUND AND
aimsIntensive Care Unit (ICU) admission is usually denied to patients with advanced hepatocellular carcinoma (HCC) due to the perceived poor prognosis associated with both cirrhosis and liver cancer. However, immunotherapy based on immune checkpoint inhibitors (ICI) has transformed the treatment landscape, and the role of critical care is becoming more relevant in managing adverse events. We aim to assess the outcome of patients with advanced HCC treated with ICI admitted to the ICU.
methodsWe evaluated patients treated with ICI combinations across 20 medical centres globally between November 2012 and April 2024. Demographic data, ICI types, causes of admission, organ support, and mortality in the short and medium term were recorded.
resultsOf 1065 patients, 47 (4.4%) were admitted to the ICU. Most were male (76.6%) with cirrhosis (93.6%), and 59.7% received ICI as first-line therapy. The primary reasons for ICU admission were immune-related adverse events (irAE) in 46.8% and variceal bleeding in 29.8%. The median time to ICU admission was 115 days [IQR 38-202] after the initiation of ICI treatment. Among patients admitted due to irAEs, the median time was 51 days [IQR 31-137]. ICU mortality was 25.5%. Two-thirds were alive 28 days post-ICU discharge, with 3- and 6-month survival rates of 83% and 69%. Of the 61.3% of survivors, they were rechallenged with ICI or started new HCC therapy.
conclusionsirAEs are the main cause of ICU admission in patients with advanced HCC receiving ICI. Despite the severity, 66% were discharged, and nearly half resumed treatment. These findings highlight the vital role of ICU care in managing HCC patients, challenging the notion of denying them intensive care.
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