Viviane B L Torres1, Luciano C P Azevedo2,3, Ulysses V A Silva4, Pedro Caruso5, André P Torelly6, Eliezer Silva7, Frederico B Carvalho8, Arthur Vianna9, Paulo C P Souza10, Michele M G Godoy11, José R A Azevedo12, Nelson Spector1, Fernando A Bozza13,14, Jorge I F Salluh1,2,13, Marcio Soares1,2,13. 1. 1 Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro. 2. 2 Postgraduate Program, National Cancer Institute. 3. 3 Research and Education Institute, Hospital Sírio-Libanês. 4. 4 ICU, Pio XII Foundation, Hospital do Câncer de Barretos, Barretos, Brazil. 5. 5 ICU, A.C. Camargo Cancer Center, and. 6. 6 Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI), Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil. 7. 7 ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil. 8. 8 ICU, Hospital Mater Dei, Belo Horizonte, Brazil. 9. 9 ICU, Clinica São Vicente. 10. 10 ICU, Hospital de Clinicas de Niteroi, Niteroi, Brazil. 11. 11 ICU, Hospital de Clinicas, Universidade Federal de Pernambuco, Recife, Brazil; and. 12. 12 ICU Hospital São Domingos-São Luís, São Luís MA, Brazil. 13. 13 D'Or Institute for Research and Education (IDOR), and. 14. 14 National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
Abstract
RATIONALE: Sepsis is a major cause of mortality among critically ill patients with cancer. Information about clinical outcomes and factors associated with increased risk of death in these patients is necessary to help physicians recognize those patients who are most likely to benefit from ICU therapy and identify possible targets for intervention. OBJECTIVES: In this study, we evaluated cancer patients with sepsis chosen from a multicenter prospective study to characterize their clinical characteristics and to identify independent risk factors associated with hospital mortality. METHODS: Subgroup analysis of a multicenter prospective cohort study conducted in 28 Brazilian intensive care units (ICUs) to evaluate adult cancer patients with severe sepsis and septic shock. We used logistic regression to identify variables associated with hospital mortality. MEASUREMENTS AND MAIN RESULTS: Of the 717 patients admitted to the participating ICUs, 268 (37%) had severe sepsis (n = 142, 53%) or septic shock (n = 126, 47%). These patients comprised the population of the present study. The mean score on the third version of the Simplified Acute Physiology Score was 62.9 ± 17.7 points, and the median Sequential Organ Failure Assessment score was 9 (7-12) points. The most frequent sites of infection were the lungs (48%), intraabdominal region (25%), bloodstream as primary infection (19%), and urinary tract (17%). Half of the patients had microbiologically proven infections, and Gram-negative bacteria were the most common pathogens causing sepsis (31%). ICU and hospital mortality rates were 42% and 56%, respectively. In multivariable analysis, the number of acute organ dysfunctions (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16-1.87), hematological malignancies (OR, 2.57; 95% CI, 1.05-6.27), performance status 2-4 (OR, 2.53; 95% CI, 1.44-4.43), and polymicrobial infections (OR, 3.74; 95% CI, 1.52-9.21) were associated with hospital mortality. CONCLUSIONS: Sepsis is a common cause of critical illness in patients with cancer and remains associated with high mortality. Variables related to underlying malignancy, sepsis severity, and characteristics of infection are associated with a grim prognosis.
RATIONALE: Sepsis is a major cause of mortality among critically illpatients with cancer. Information about clinical outcomes and factors associated with increased risk of death in these patients is necessary to help physicians recognize those patients who are most likely to benefit from ICU therapy and identify possible targets for intervention. OBJECTIVES: In this study, we evaluated cancerpatients with sepsis chosen from a multicenter prospective study to characterize their clinical characteristics and to identify independent risk factors associated with hospital mortality. METHODS: Subgroup analysis of a multicenter prospective cohort study conducted in 28 Brazilian intensive care units (ICUs) to evaluate adult cancerpatients with severe sepsis and septic shock. We used logistic regression to identify variables associated with hospital mortality. MEASUREMENTS AND MAIN RESULTS: Of the 717 patients admitted to the participating ICUs, 268 (37%) had severe sepsis (n = 142, 53%) or septic shock (n = 126, 47%). These patients comprised the population of the present study. The mean score on the third version of the Simplified Acute Physiology Score was 62.9 ± 17.7 points, and the median Sequential Organ Failure Assessment score was 9 (7-12) points. The most frequent sites of infection were the lungs (48%), intraabdominal region (25%), bloodstream as primary infection (19%), and urinary tract (17%). Half of the patients had microbiologically proven infections, and Gram-negative bacteria were the most common pathogens causing sepsis (31%). ICU and hospital mortality rates were 42% and 56%, respectively. In multivariable analysis, the number of acute organ dysfunctions (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16-1.87), hematological malignancies (OR, 2.57; 95% CI, 1.05-6.27), performance status 2-4 (OR, 2.53; 95% CI, 1.44-4.43), and polymicrobial infections (OR, 3.74; 95% CI, 1.52-9.21) were associated with hospital mortality. CONCLUSIONS:Sepsis is a common cause of critical illness in patients with cancer and remains associated with high mortality. Variables related to underlying malignancy, sepsis severity, and characteristics of infection are associated with a grim prognosis.
Authors: John D Lyons; Ching-Wen Chen; Zhe Liang; Wenxiao Zhang; Deena B Chihade; Eileen M Burd; Alton B Farris; Mandy L Ford; Craig M Coopersmith Journal: Shock Date: 2019-06 Impact factor: 3.454
Authors: Fernando G Zampieri; Fernando A Bozza; Giulliana M Moralez; Débora D S Mazza; Alexandre V Scotti; Marcelo S Santino; Rubens A B Ribeiro; Edison M Rodrigues Filho; Maurício M Cabral; Marcelo O Maia; Patrícia S D'Alessandro; Sandro V Oliveira; Márcia A M Menezes; Eliana B Caser; Roberto S Lannes; Meton S Alencar Neto; Maristela M Machado; Marcelo F Sousa; Jorge I F Salluh; Marcio Soares Journal: Intensive Care Med Date: 2016-09-29 Impact factor: 17.440
Authors: Frank Daniel Martos-Benítez; Andrés Soto-García; Anarelys Gutiérrez-Noyola Journal: J Cancer Res Clin Oncol Date: 2018-01-23 Impact factor: 4.553
Authors: Justin Xavier Moore; Tomi Akinyemiju; Alfred Bartolucci; Henry E Wang; John Waterbor; Russell Griffin Journal: Cancer Epidemiol Date: 2018-05-25 Impact factor: 2.984