Sepsis and Septic Shock in Patients With Malignancies: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study*

Abstract

Objectives: Cancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades. Data Source: Seven European ICUs. Study Selection: A hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors for day 30 mortality. Data Extraction: Data from cancer patients admitted to ICUs for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994–2015). Data Synthesis: Overall, 2,062 patients (62% men, median [interquartile range] age 59 yr [48–67 yr]) were included in the study. Underlying malignancies were solid tumors (n = 362; 17.6%) or hematologic malignancies (n = 1,700; 82.4%), including acute leukemia (n = 591; 28.7%), non-Hodgkin lymphoma (n = 461; 22.3%), and myeloma (n = 244; 11.8%). Two-hundred fifty patients (12%) underwent allogeneic hematopoietic stem cell transplantation and 640 (31.0%) were neutropenic at ICU admission. Day 30 mortality was 39.9% (823 deaths). The year of ICU admission was associated with significant decrease in day 30 mortality over time (odds ratio, 0.96; 95% CI, 0.93–0.98; p = 0.001). Mechanical ventilation (odds ratio, 3.25; 95% CI, 2.52–4.19; p < 0.01) and vasopressors use (odds ratio, 1.42; 95% CI, 1.10–1.83; p < 0.01) were independently associated with day 30 mortality, whereas underlying malignancy, allogeneic hematopoietic stem cell transplantation, and neutropenia were not. Conclusions: Survival in critically ill oncology and hematology patients with sepsis improved significantly over time. As outcomes improve, clinicians should consider updating admission policies and goals of care in this population.

Predicting 30-days mortality for MIMIC-III patients with sepsis-3: a machine learning approach using XGboost

“…There is no doubt that age and metastatic cancer as basic demographic information could be included in the model which plays unfavorable effects for the mortality. Whereas, survival in critically ill cancer patients with sepsis improved significantly over time but reasons or mechanisms for this condition haven't been identified [45]. In consideration of the source of infection, we found blood infection ranks the highest (38.49%), followed by MRSA screen (35.49%) and urine (17.36%), which indicates that we can perform empirical antibiotics treatment, but de-escalation or determination of whether or not to stop antibiotics or successful implementation of antimicrobial stewardship may help to improve a patient's clinical prognosis while preventing adverse outcomes [46].…”

Successful treatment of pulmonary haemorrhage and acute respiratory distress syndrome caused by fulminant Stenotrophomonas maltophilia respiratory infection in a patient with acute lymphoblastic leukaemia – case report

“…Furthermore, according to other reports, survival was higher for patients who underwent a first-line chemotherapy, had lobar ARDS and who received antibiotic treatment active on difficult-to-treat bacteria like Pseudomonas aeruginosa and Stenotrophomonas maltophilia [11]. The duration of neutropenia seems to be correlated with short-term mortality, while 30-day mortality is affected by organ dysfunction [12,13].…”

“…The decision to continue IV colistin has been taken considering the fact that the patient has been already exposed to levofloxacin, the possibility of a MDR germ and the unknown bioavailability of enterally administered TMP/SMX in a severely ill patient with reactive digestive ileus and gastric stasis (the IV form is not available in our country). Some retrospective studies have shown that, during ICU stay, the absence of neutropenia recovery and the presence of organ failure are associated with poor outcome in the critically ill patient with malignancy [11,12]. Furthermore, according to other reports, survival was higher for patients who underwent a first-line chemotherapy, had lobar ARDS and who received antibiotic treatment active on difficult-to-treat bacteria like Pseudomonas aeruginosa and Stenotrophomonas maltophilia [11].…”

“…Some retrospective studies have shown that, during ICU stay, the absence of neutropenia recovery and the presence of organ failure are associated with poor outcome in the critically ill patient with malignancy [ 11 , 12 ]. Furthermore, according to other reports, survival was higher for patients who underwent a first-line chemotherapy, had lobar ARDS and who received antibiotic treatment active on difficult-to-treat bacteria like Pseudomonas aeruginosa and Stenotrophomonas maltophilia [ 11 ].…”

The Management of Hematologic Patients with Bloodstream Infections Due to Multi-Drug Resistant Bacteria: Where Do We Stand? From Antibacterial Prophylaxis to the Treatment of Septic Shock

“…A full code status with a time-limited trial and frequent reassessment should be applied in patients with a potentially reversible cause of deterioration or uncertain prognosis [76,77]. Neutropenia should no longer be considered a negative prognostic factor in managing these patients, even in allo−HSCT recipients [78][79][80]. A meta-analysis of more than 2000 HSCT patients in the ICU showed the main prognostic factors of mortality were multi-organ failures requiring support and uncontrolled graft versus host disease (GVHD), not septic shock, underlying malignancy or disease status, suggesting that they should not be used in the ICU transfer decision process [81].…”