Association Between Positive Cultures During Admission and 1-Year Mortality in Patients With Cancer Receiving Perioperative Intensive Care

Abstract

The number of patients with cancer being admitted to intensive care units (ICUs) is increasing worldwide, and these patients are vulnerable to infection. This study aimed to address the long-term impact of positive cultures during admission on 1-year mortality among patients with cancer who received perioperative intensive care. This retrospective cohort study enrolled adult patients with cancer who were admitted to ICUs and received surgery during 2011 to 2016 at a tertiary hospital in central Taiwan. Cancer-related data were retrieved from the cancer registry, and data during ICU admissions were obtained from the electronic medical records. We compared the survival curves between patients with and without positive clinical cultures using log-rank test and used a multivariable Cox proportional hazards regression model to evaluate the influence of positive clinical cultures on 1-year mortality. A total of 638 patients were included for analyses, and 37.9% of them had positive cultures during the index admission. In-hospital mortality was 9.1%, while 1-year mortality was 21.0%. Compared with patients who survived, patients who died were significantly more likely to have positive cultures (59.7% vs 32.1%), to have a higher Acute Physiology and Chronic Health Evaluation II scores (median 21.8 vs 19.0), and to receive mechanical ventilation (86.6% vs 77.4%). Survival analysis found that positive cultures of blood, the respiratory tract, the urinary tract, or the skin and soft tissue were associated with an increased 1-year mortality. Multivariable Cox proportional hazards regression analysis found that positive cultures of blood, the respiratory tract, the urinary tract, or the skin and soft tissue (hazard ratio: 1.621; 95% confidence interval: 1.087-2.419) were significantly associated with 62.1% increased hazards of death within 1 year after the ICU admission. A positive culture during admission was associated with a worsened long-term survival among patients with cancer who received perioperative intensive care. Further studies are needed to confirm this association.

Impact of Early Fluid Balance on 1-Year Mortality in Critically Ill Patients With Cancer: A Retrospective Study in Central Taiwan

“…Our previous study as well as other investigations have found that older age, use of benzodiazepine, immunosuppression profiles, and positive culture in blood, urine, as well as blood, may have an effect on mortality, physical decline, and development of further infection in patients who are discharged from the ICU. 23 - 25 As detailed information on fluid balance during ICU admission is rarely recorded in studies whose primary aim is to analyze cancer-related data, such as the cancer registry database, the long-term impact of fluid balance on critically ill patients with cancer remains unclear.…”

The association between culture positivity and long-term mortality in critically ill surgical patients

“…The aforementioned data showed that culture positivity appears to be associated with long-term outcomes instead of short-term outcomes; therefore, there is an essential need for studies focusing on long-term outcomes in critically ill patients. Our previous study found a long-term mortality impact of culture positivity in 638 critically ill cancer patients receiving surgery during ICU admission [ 15 ]. In the present study, we enrolled a relatively large number of patients who were admitted to surgical ICUs and provide evidence that culture positivity affects the long-term mortality in critically ill patients.…”

“…The culture cites compromised of blood, respiratory tract (sputum, tracheal aspirate, pleural effusion, and bronchoalveolar lavage fluid), urinary tract (midstream urine, urine via urinary catheter, and urine via percutaneous nephrostomy), skin and soft tissue (surgical wound, pus, and discharge), or abdomen (ascites, bile, and drainage of abdominal drainage tube) during the index admission [ 15 ]. The pathogens were categorised by Gram-negative bacilli, Gram-positive cocci, and Fungi, including Candida and Aspergillus [ 15 ]. The microbiologic test was performed based on the decision made by individual physicians if patients had a fever or an infection was suspected.…”

“…Kaplan–Meier analysis was performed to illustrate the association between mortality and microbial results. Variables that might affect long-term mortality in critically ill patients based on previous studies including our study were included in the multivariable model [ 15 , 18 ]. The Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality after adjustment for age, sex, CCI, and potential cofounders including early fluid balance, a predictor for long-term outcome in critically ill cancer patients as we have shown in our previous study [ 19 ].…”

“…Recent studies have explored the association between culture positivity, a positive microbial culture of clinical samples during admission, and mortality in critically ill patients, but the evidence appeared to be inconclusive due to high heterogeneity among studies, with the majority of studies explored the short-term impact of culture positivity among patients with sepsis in the medical ICU [ 12 – 14 ]. Few studies, including our previous study focusing on 638 patients with cancer receiving perioperative intensive care, have found that culture positivity tended to be associated with 1-year mortality instead of short-term mortality [ 15 , 16 ].…”