Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon

Abstract

ObjectiveMost sepsis studies have looked at the general population. The aim of this study is to report on the characteristics, treatment and hospital mortality of patients with cancer diagnosed with sepsis or septic shock.SettingA single-centre retrospective study at a tertiary care centre looking at patients with cancer who presented to our tertiary hospital with sepsis, septic shock or bacteraemia between 2010 and 2015.Participants176 patients with cancer were compared with 176 cancer-free controls.Primary and secondary outcomesThe primary outcome of this study was the in hospital mortality in both cohorts. Secondary outcomes included patient demographics, emergency department (ED) vital signs and parameters of resuscitation along with laboratory work.ResultsA total of 352 patients were analysed. The mean age at presentation for the cancer group was 65.39±15.04 years, whereas the mean age for the control group was 74.68±14.04 years (p<0.001). In the cancer cohort the respiratory system was the most common site of infection (37.5%) followed by the urinary system (26.7%), while in the cancer-free arm, the urinary system was the most common site of infection (40.9%). intravenous fluid replacement for the first 24 hours was higher in the cancer cohort. ED, intensive care unit and general practice unit length of stay were comparable in both the groups. 95 (54%) patients with cancer died compared with 75 (42.6%) in the cancer-free group. The 28-day hospital mortality in the cancer cohort was 87 (49.4%) vs 46 (26.1%) in the cancer-free cohort (p=0.009). Patients with cancer had a 2.320 (CI 95% 1.225 to 4.395, p=0.010) odds of dying compared with patients without cancer in the setting of sepsis.ConclusionsThis is the first study looking at an in-depth analysis of sepsis in the specific oncology population. Despite aggressive care, patients with cancer have higher hospital mortality than their cancer-free counterparts while adjusting for all other variables.

Past history of stage I/II solid tumor malignancy impacts considerably on sepsis mortality: a propensity score matching analysis from the hellenic sepsis study group

“…These were compared to another 176 non-oncological patients coming from the same database. Although the hospital mortality of the oncological patients was significantly greater than the non-oncological patients, their severity as defined by their vital signs and requirement for vasopressors was also significantly greater than the non-oncological patients [15]. The second study is a retrospective analysis of the REGARDS database.…”

Utilidad clínica del lactato en el paciente oncológico

“…Abou et al (Dagher et al, 2017) estudiaron, 352 pacientes, 176 con cáncer se compararon con 176 sin cáncer, los resultados, describen, que el nivel sérico de lactato, a la presentación en emergencia de los pacientes con cáncer fue de 4mg/dl, 44 % del grupo de cáncer vs 26 % del grupo control. En otros estudios, el nivel de lactato en pacientes con cáncer e infección se ha tomado con un corte de 2,98mmol/L, pero este valor ha tenido poco valor discriminativo (Keçe et al, 2016).…”

“…En el año 2010 Mato et al (Dagher et al, 2017), encontraron que, en pacientes con neutropenia febril, quienes no presentaban inestabilidad cardiovascular, una elevación de lactato ¿2mmol/L, dentro de las 26 horas iniciales, de seguimiento de la neutropenia febril, podría predecir, infección con riesgo elevado de inestabilidad cardiovascular y choque.…”

Sepsis-associated pathways segregate cancer groups

“…Another association study revealed 2.5 fold increased risk of sepsis in survivors of cancer in community-dwelling adults (the risk is increased up to 10 times in hospitalized cancer patients) [3]. Co-occurrence of cancer with sepsis is associated with higher mortality than sepsis alone without cancer [4]. On the other hand, sepsis is a common cause of death in critically ill patients with cancer, with high ICU and hospital mortality [5][6][7].…”