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Sepsis-Associated Outcomes in Critically Ill Patients with Malignancies.
Ann Am Thorac Soc. 2015 Jun 18;
Authors: Torres VB, Azevedo LC, Silva UV, Caruso P, Torelly AP, Silva E, Carvalho FB, Vianna A, Souza PC, Godoy MM, Azevedo JR, Spector N, Bozza FA, Salluh JI, Soares M
Abstract
RATIONALE: Sepsis is a major cause of mortality for critically ill patients with cancer. Information about clinical outcomes and factors associated with increased risk of death in these patients are necessary to help physicians recognize those patients who are most likely to benefit from ICU therapy and identify possible targets for intervention.
OBJECTIVES: In this study, we evaluated cancer patients with sepsis from a multicenter prospective study in order to characterize their clinical characteristics and to identify independent risk factors associated with hospital mortality.
METHODS: Subgroup analysis of a multicenter prospective cohort study conducted in 28 Brazilian intensive care units (ICUs) evaluating adult cancer patients with severe sepsis and septic shock. We used logistic regression to identify variables associated with hospital mortality.
MEASUREMENTS AND MAIN FINDINGS: Out of the 717 patients admitted to the participating ICUs, 268 (37%) had severe sepsis (n=142, 53%) or septic shock (n=126, 47%) and comprised the population of this study. Mean SAPS 3 score was 62.9±17.7 points and median SOFA score was 9 (7-12) points, respectively. The most frequent sites of infection were the lungs (48%), intra-abdominal (25%), primary bloodstream infections (19%) and urinary tract (17%). Half of patients had microbiologically proven infections and Gram-negative bacteria were the most common pathogens causing sepsis (31%). ICU and hospital mortality rates were 42% and 56%, respectively. In multivariable analysis, the number of acute organ dysfunctions [odds-ratio (OR)=1.48(95% CI, 1.16-1.87)], hematological malignancy [OR=2.57 (1.05-6.27)], performance status 2-4 [OR=2.53(1.44-4.43)] and polymicrobial infections [OR=3.74 (1.52-9.21)] were associated with hospital mortality.
CONCLUSIONS: Sepsis is a common cause of critical illness in cancer patients and remains associated with high mortality. Variables related to underlying malignancy, sepsis severity and characteristics of infection are associated with grim prognosis.
PMID: 26086679 [PubMed - as supplied by publisher]