Outcomes and Predictors of 28-Day Mortality in Patients With Solid Tumors and Septic Shock Defined by Third International Consensus Definitions for Sepsis and Septic Shock Criteria

Cuenca, John; Manjappachar, Nirmala; Ramirez, Claudia; Hernandez, Mike; Martin, Peyton; Gutiérrez, Cristina; Rathi, Nisha; Sprung, Charles L.; Price, Kristen; Nates, Joseph L.

doi:10.1016/j.chest.2022.05.017

Cited by 18 publications

(13 citation statements)

References 37 publications

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“…The significance of septic shock in the prognosis of nosocomial infections in cancer patients is well documented ( Chen et al., 2017 ; Palacios-Baena et al., 2017 ; Antonio et al., 2019 ; Jiang et al., 2020a ; Gudiol et al., 2021 ; Jiang et al., 2022 ). Septic shock is defined as a life-threatening subset of sepsis that can cause multiorgan failure and is associated with higher mortality ( Singer et al., 2016 ; Cuenca et al., 2022 ). Sepsis and septic shock are among the most common reasons for ICU admission in patients with malignancy ( Cuenca et al., 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…Septic shock is defined as a life-threatening subset of sepsis that can cause multiorgan failure and is associated with higher mortality ( Singer et al., 2016 ; Cuenca et al., 2022 ). Sepsis and septic shock are among the most common reasons for ICU admission in patients with malignancy ( Cuenca et al., 2022 ). It is reported that cancer patients who experienced septic shock have a 1.85-fold hospital mortality compared to the general population ( Buchman et al., 2020a ; Buchman et al., 2020b ; Awad et al., 2021 ; Manjappachar et al., 2022 ).…”

Section: Discussionmentioning

confidence: 99%

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A novel risk classifier to predict the in-hospital death risk of nosocomial infections in elderly cancer patients

Jiang

Zhao

et al. 2023

Front. Cell. Infect. Microbiol.

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BackgroundElderly cancer patients are more predisposed to developing nosocomial infections during anti-neoplastic treatment, and are associated with a bleaker prognosis. This study aimed to develop a novel risk classifier to predict the in-hospital death risk of nosocomial infections in this population.MethodsRetrospective clinical data were collected from a National Cancer Regional Center in Northwest China. The Least Absolute Shrinkage and Selection Operator (LASSO) algorithm was utilized to filter the optimal variables for model development and avoid model overfitting. Logistic regression analysis was performed to identify the independent predictors of the in-hospital death risk. A nomogram was then developed to predict the in-hospital death risk of each participant. The performance of the nomogram was evaluated using receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA).ResultsA total of 569 elderly cancer patients were included in this study, and the estimated in-hospital mortality rate was 13.9%. The results of multivariate logistic regression analysis showed that ECOG-PS (odds ratio [OR]: 4.41, 95% confidence interval [CI]: 1.95-9.99), surgery type (OR: 0.18, 95%CI: 0.04-0.85), septic shock (OR: 5.92, 95%CI: 2.43-14.44), length of antibiotics treatment (OR: 0.21, 95%CI: 0.09-0.50), and prognostic nutritional index (PNI) (OR: 0.14, 95%CI: 0.06-0.33) were independent predictors of the in-hospital death risk of nosocomial infections in elderly cancer patients. A nomogram was then constructed to achieve personalized in-hospital death risk prediction. ROC curves yield excellent discrimination ability in the training (area under the curve [AUC]=0.882) and validation (AUC=0.825) cohorts. Additionally, the nomogram showed good calibration ability and net clinical benefit in both cohorts.ConclusionNosocomial infections are a common and potentially fatal complication in elderly cancer patients. Clinical characteristics and infection types can vary among different age groups. The risk classifier developed in this study could accurately predict the in-hospital death risk for these patients, providing an important tool for personalized risk assessment and clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A novel risk classifier to predict the in-hospital death risk of nosocomial infections in elderly cancer patients

Jiang

Zhao

et al. 2023

Front. Cell. Infect. Microbiol.

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“…Although the largest study evaluated in this meta-analysis – a retrospective 7-hospital cohort study of over 2000 patients from Lemiale et al – showed improving mortality over time, these mortality rates remain substantially higher than rates in unselected cohorts with ICU sepsis or septic shock [40,41]. Finally, in a pair of studies from the same US-based cancer care center, Manjapacchar et al and Cuenca et al described the characteristics and outcomes of septic shock – defined by strict adherence to the Sepsis-3 definition [42] – in patients with hematologic malignancies ( n = 459) and solid tumors ( n = 271), respectively [43 ▪▪ ,44 ▪▪ ]. In each of these cohorts, 28-day mortality was approximately 67% and 90-day mortality was approximately 80%.…”

Section: Outcomes In Oncologic Critical Illness – Recent Updatesmentioning

confidence: 97%

Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?

Lyons,

McEvoy,

Hayes-Lattin

2023

Current Opinion in Critical Care

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Purpose of review Care and outcomes of critically ill patients with cancer have improved over the past decade. This selective review will discuss recent updates in sepsis and acute respiratory failure among patients with cancer, with particular focus on important opportunities to improve outcomes further through attention to phenotyping, predictive analytics, and improved outcome measures. Recent findings The prevalence of cancer diagnoses in intensive care units (ICUs) is nontrivial and increasing. Sepsis and acute respiratory failure remain the most common critical illness syndromes affecting these patients, although other complications are also frequent. Recent research in oncologic sepsis has described outcome variation – including ICU, hospital, and 28-day mortality – across different types of cancer (e.g., solid vs. hematologic malignancies) and different sepsis definitions (e.g., Sepsis-3 vs. prior definitions). Research in acute respiratory failure in oncology patients has highlighted continued uncertainty in the value of diagnostic bronchoscopy for some patients and in the optimal respiratory support strategy. For both of these syndromes, specific challenges include multifactorial heterogeneity (e.g. in etiology and/or underlying cancer), delayed recognition of clinical deterioration, and complex outcomes measurement. Summary Improving outcomes in oncologic critical care requires attention to the heterogeneity of cancer diagnoses, timely recognition and management of critical illness, and defining appropriate ICU outcomes.

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“…The Third International Sepsis Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) incorporated a serum lactate level of greater than 2 mmol/L into the diagnostic criteria for septic shock (2). Although high lactate (HL) levels have been associated with increased mortality rates in patients with and without cancer, few studies have directly assessed the longterm survival of cancer patients fulfilling the Sepsis-3 criteria for septic shock (3)(4)(5)(6). Our two retrospective cohorts of patients with cancer and septic shock showed a significantly higher short-term mortality rate between patients that fulfilled the Sepsis-3 criteria and those that did not (4,5).…”

mentioning

confidence: 99%

“…Although high lactate (HL) levels have been associated with increased mortality rates in patients with and without cancer, few studies have directly assessed the longterm survival of cancer patients fulfilling the Sepsis-3 criteria for septic shock (3)(4)(5)(6). Our two retrospective cohorts of patients with cancer and septic shock showed a significantly higher short-term mortality rate between patients that fulfilled the Sepsis-3 criteria and those that did not (4,5). However, both studies focused on short-term risk factors for mortality rather than the long-term survival.…”

mentioning

confidence: 99%

Long-Term Survival of Patients With Cancer, Sepsis, and Vasopressor Requirements Based on Lactate Levels

Cuenca,

Nates,

Laserna

et al. 2024

Critical Care Explorations

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A prospective cohort study was conducted to evaluate the 1-year survival of cancer patients with sepsis and vasopressor requirements. Eligible patients were admitted a Comprehensive Cancer Center’s ICU and were compared based on their admission lactate levels. Of the 132 included patients, 87 (66%) had high lactate (HL; > 2.0 mmol/L), and 45 (34%) had normal lactate (NL; ≤ 2.0 mmol/L). The 1-year survival rates of the two groups were similar (HL 16% vs. NL 18%; p = 0.0921). After adjustment for ICU baseline characteristics, HL was not significantly associated with a 1-year survival (Hazards ratio, 1.39; 95% CI, 0.94–2.05). Critically ill cancer patients with sepsis and vasopressor requirements, regardless of the lactate level, had 1-year survival of less than 20%. Large multicenter cancer registries would enable to confirm our findings and better understand the long-term trajectories of sepsis in this vulnerable population.

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Outcomes and Predictors of 28-Day Mortality in Patients With Solid Tumors and Septic Shock Defined by Third International Consensus Definitions for Sepsis and Septic Shock Criteria

Cited by 18 publications

References 37 publications

A novel risk classifier to predict the in-hospital death risk of nosocomial infections in elderly cancer patients

A novel risk classifier to predict the in-hospital death risk of nosocomial infections in elderly cancer patients

Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?

Long-Term Survival of Patients With Cancer, Sepsis, and Vasopressor Requirements Based on Lactate Levels

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