OBJECTIVE: To determine whether the survival gains achieved in critically ill cancer patients in recent years exist in the subset with neutropenia and severe sepsis or septic shock. DESIGN: Retrospective 11-yr study (1998-2008). SETTING: Medical intensive care unit in a teaching hospital. PATIENTS: Four hundred twenty-eight intensive care unit patients with cancer, neutropenia, and severe sepsis or septic shock. The primary outcome was hospital mortality. RESULTS: The main underlying diseases were acute leukemia (35.7%), lymphoma (31.7%), and solid tumors (16.5%). Two hundred thirty-seven (55.5%) patients had microbiologically documented infections, 141 (32.9%) clinically documented infections, and 50 (11.9%) fever of unknown origin. Acute noninfectious conditions were diagnosed in 175 of 428 (41%) patients, including 26 of 50 (52%) patients with fever of unknown origin, 66 of 141 (47%) patients with clinically documented infections, and 83 of 237 (35%) patients with microbiologically documented infections. Early indwelling catheter removal was performed routinely in the 107 (25%) patients without clinical evidence of a septic focus at intensive care unit admission. Early beta-lactam plus aminoglycoside therapy was used in 391 (91.3%) patients. Hospital mortality was 49.8%. Hospital mortality decreased from 58.7% (108 of 184) in 1998-2003 to 43% in 2004-2008 (105 of 244, p = .006). Multivariate analysis identified nine independent predictors of hospital mortality, of which six were associated with higher mortality (older age; need for vasopressors; neurologic, respiratory, or hepatic dysfunction; and acute noninfectious condition) and three with lower mortality (intensive care unit admission after 2003, combination antibiotic therapy including an aminoglycoside, and early indwelling catheter removal). CONCLUSION: In neutropenic patients with severe sepsis or septic shock, survival improved over time. Aminoglycoside use and early catheter removal in patients with undocumented sepsis may improve survival. Acute noninfectious conditions are associated with increased mortality, underlining the need for thorough and repeated clinical assessments.
OBJECTIVE: To determine whether the survival gains achieved in critically ill cancerpatients in recent years exist in the subset with neutropenia and severe sepsis or septic shock. DESIGN: Retrospective 11-yr study (1998-2008). SETTING: Medical intensive care unit in a teaching hospital. PATIENTS: Four hundred twenty-eight intensive care unit patients with cancer, neutropenia, and severe sepsis or septic shock. The primary outcome was hospital mortality. RESULTS: The main underlying diseases were acute leukemia (35.7%), lymphoma (31.7%), and solid tumors (16.5%). Two hundred thirty-seven (55.5%) patients had microbiologically documented infections, 141 (32.9%) clinically documented infections, and 50 (11.9%) fever of unknown origin. Acute noninfectious conditions were diagnosed in 175 of 428 (41%) patients, including 26 of 50 (52%) patients with fever of unknown origin, 66 of 141 (47%) patients with clinically documented infections, and 83 of 237 (35%) patients with microbiologically documented infections. Early indwelling catheter removal was performed routinely in the 107 (25%) patients without clinical evidence of a septic focus at intensive care unit admission. Early beta-lactam plus aminoglycoside therapy was used in 391 (91.3%) patients. Hospital mortality was 49.8%. Hospital mortality decreased from 58.7% (108 of 184) in 1998-2003 to 43% in 2004-2008 (105 of 244, p = .006). Multivariate analysis identified nine independent predictors of hospital mortality, of which six were associated with higher mortality (older age; need for vasopressors; neurologic, respiratory, or hepatic dysfunction; and acute noninfectious condition) and three with lower mortality (intensive care unit admission after 2003, combination antibiotic therapy including an aminoglycoside, and early indwelling catheter removal). CONCLUSION: In neutropenicpatients with severe sepsis or septic shock, survival improved over time. Aminoglycoside use and early catheter removal in patients with undocumented sepsis may improve survival. Acute noninfectious conditions are associated with increased mortality, underlining the need for thorough and repeated clinical assessments.
Authors: Lisa M Daniels; Urshila Durani; Jason N Barreto; John C O'Horo; Mustaqeem A Siddiqui; John G Park; Pritish K Tosh Journal: Support Care Cancer Date: 2019-02-25 Impact factor: 3.603
Authors: I Suárez; B Böll; A Shimabukuro-Vornhagen; G Michels; M von Bergwelt-Baildon; M Kochanek Journal: Med Klin Intensivmed Notfmed Date: 2015-05-21 Impact factor: 0.840
Authors: Elie Azoulay; Peter Schellongowski; Michael Darmon; Philippe R Bauer; Dominique Benoit; Pieter Depuydt; Jigeeshu V Divatia; Virginie Lemiale; Maarten van Vliet; Anne-Pascale Meert; Djamel Mokart; Stephen M Pastores; Anders Perner; Frédéric Pène; Peter Pickkers; Kathryn A Puxty; Francois Vincent; Jorge Salluh; Ayman O Soubani; Massimo Antonelli; Thomas Staudinger; Michael von Bergwelt-Baildon; Marcio Soares Journal: Intensive Care Med Date: 2017-07-19 Impact factor: 17.440
Authors: Youn-Jung Kim; Sung Min Jung; Jihoon Kang; Seung Mok Ryoo; Chang Hwan Sohn; Dong-Woo Seo; Kyoung Soo Lim; Jin Won Huh; Sung-Han Kim; Won Young Kim Journal: Intern Emerg Med Date: 2019-01-01 Impact factor: 3.397