Cancer patients with sepsis admitted to a specialized onco-medical ICU: incidence, ICU course and outcome

Abstract

Introduction Fibrinolytic shutdown plays a pivotalrole in the pathogenesis of multiple organ dysfunction syndrome (MODS) in disseminated intravascular coagulation (DIC). We tested the hypothesis that the levels of thrombin activatable fi brinolysis inhibitor (TAFI) are not suffi cient to overcome fi brinolytic shutdown, thus contributing to MODS and the poor prognosis in sepsis-induced DIC. Methods Fifty patients with sepsis, severe sepsis, or septic shock were enrolled in the study. The DIC was diagnosed based on the Japanese Association for Acute Medicine (JAAM) DIC criteria. The overt DIC scores based on the International Society on Thrombosis and Haemostasis (ISTH) were also calculated. On the day of sepsis diagnosis (day 1), and days 3 and 5, we measured TAFI, soluble fi brin, and global coagulation and fi brinolysis markers. Results The JAAM DIC scores on day 1 and maximum JAAM DIC scores were independent predictors of patient death and MODS, respectively. The JAAM DIC patients, especially those who simultaneously met the ISTH overt DIC criteria, showed lower TAFI antigen levels and activity, and higher levels of soluble fi brin in comparison with non-DIC patients. There were diff erences in the levels of soluble fi brin and TAFI activity between the patients with and without MODS. The fi ndings of stepwise logistic regression and multiple regression analyses suggested that low TAFI activity is an independent predictor of patient death and MODS. A multiple regression analysis also indicated that soluble fi brin negatively correlated with the TAFI activity in DIC patients. Conclusion Thrombin activation results in the consumption of TAFI. Low TAFI activity is involved in the pathogenesis of DIC-induced MODS and poor prognosis.

Oncological patients in the intensive care unit: prognosis, decision-making, therapies and end-of-life care

“…However, perceptible improvements in the prognosis of acutely ill oncological patients, including paediatric patients, have been achieved in recent years [25][26][27]. In fact, since 2002 some reports have mentioned ICU admission as an independent favourable prognostic factor for short-term outcome [17,[28][29][30]. Admission to the ICU worsens the prognosis of a cancer patient substan-tially; however, the stage of the malignancy has little or no impact on short-term survival [5,11].…”