1068 Risk of ICU admission after immune checkpoint inhibitor use: real-world data analysis at a national level

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Background Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy, offering survival benefits across diverse malignancies. Alongside these benefits, immune activation can lead to various immune-related adverse events (irAEs). While ICI efficacy and toxicities have been well-described, data on ICI associated hospitalizations and intensive care unit (ICU) admissions remain limited. Most existing studies are constrained by small cohorts or single-center designs, limiting broader applicability. Given the growing use of ICIs, there is a pressing need to better understand their real-world impact on healthcare utilization. In this study, we leveraged two large national databases to describe inpatient and ICU admissions within 90 days of ICI initiation, characterizing underlying causes, and cancer and ICI types.Methods We used the MarketScan Commercial Claims and Medicaid databases (2016–2022) to identify patients with solid organ malignancies who received ICIs. ICIs were identified using Healthcare Common Procedure Coding System codes, and cancer diagnoses via International Classification of Diseases codes. Using the date of first ICI administration as the index date, we identified inpatient and ICU admissions within 90 days. ICU admissions were identified using Current Procedure terminology (CPT) code 99291 and the primary diagnosis of ICU admission. We examined the cancer type, ICI type, and reasons for hospital and ICU admissions within 90-days.Results A total of 33,040 patients received ICI for solid organ malignancies in the two databases of which 48.9% were male and 51.1% were female. The most common ICIs were Pembrolizumab (16276, 45.38%), Nivolumab (10548, 29.41%), Ipilimumab (3120, 8.70%), and Atezolizumab (3092, 8.62%). Lung cancer was the most common malignancy (n=13,497, 40.8%), followed by genitourinary (n=5,449, 16%), melanoma (n=4,442, 13%), gastrointestinal (n=4,103, 12%), and breast (n=3,585, 10%). The rates of hospitalization and ICU admission within 90 days of start of ICI were 22.0% (n=7216) and 8.7% (n=2872, 40% of total hospitalizations), respectively.The most common reasons for ICU admission were infectious (29.6%), respiratory (7%) and gastrointestinal (6.5%). Ipilimumab was associated with the highest risk of ICU admission at 12%, followed by Nivolumab (10%), Atezolizumab (9%), and Pembrolizumab (8%).Conclusions In our cohort of 33,040 patients, 22% required hospitalization and 8.7% required ICU admission (40% of total hospitalizations) within 90 days of ICI therapy. Infections remain the most common reason for such admissions. Though ICIs are generally better tolerated than traditional chemotherapy, hospitalization and ICU admissions are not uncommon.

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