Fabrice Camou1, Marion Didier1, Thibaut Leguay2, Noël Milpied2, Amaury Daste3, Alain Ravaud3, Gaëlle Mourissoux1, Olivier Guisset1, Nahéma Issa4,5. 1. Intensive Care and Infectious Disease Unit, CHU Bordeaux, 33000, Bordeaux, France. 2. Hematology, CHU Bordeaux, 33000, Bordeaux, France. 3. Oncology, CHU Bordeaux, 33000, Bordeaux, France. 4. Intensive Care and Infectious Disease Unit, CHU Bordeaux, 33000, Bordeaux, France. nahema.issa@chu-bordeaux.fr. 5. Hôpital Saint-André, 1 rue Jean Burguet, 33075, Bordeaux, France. nahema.issa@chu-bordeaux.fr.
Abstract
OBJECTIVES: In the last decades, the number of cancer patients admitted in intensive care units (ICUs) for septic shock has dramatically increased. However, prognosis data remain scarce. METHODS: To assess the 180-day mortality rate in cancer patients admitted to the ICU for septic shock, a 5-year prospective study was performed. All adult patients admitted for septic shock were included and categorized into the following two groups and four subgroups: cancer patients (solid tumor or hematological malignancy) and non-cancer patients (immunocompromised or not). Data were collected and compared between the groups. Upon early ICU admission, the decision to forgo life-sustaining therapy (DFLST) or not was made by consultation among hematologists, oncologists, and the patients or their relatives. RESULTS: During the study period, 496 patients were admitted for septic shock: 252 cancer patients (119 hematological malignancies and 133 solid tumors) and 244 non-cancer patients. A DFLST was made for 39% of the non-cancer patients and 52% of the cancer patients. The 180-day mortality rate among the cancer patients was 51% and 68% for those with hematological malignancies and solid cancers, respectively. The mortality rate among the non-cancer patients was 44%. In a multivariate analysis, the performance status, Charlson comorbidity index, simplified acute physiology score 2, sequential organ failure assessment score, and DFLST were independent predictors of 180-day mortality. CONCLUSIONS: Despite early admission to the ICU, the 180-day mortality rate due to septic shock was higher in cancer patients compared with non-cancer patients, due to excess mortality in the patients with solid tumors. The long-term prognosis of cancer patients with septic shock is modulated by their general state, severity of organ failure, and DFLST.
OBJECTIVES: In the last decades, the number of cancerpatients admitted in intensive care units (ICUs) for septic shock has dramatically increased. However, prognosis data remain scarce. METHODS: To assess the 180-day mortality rate in cancerpatients admitted to the ICU for septic shock, a 5-year prospective study was performed. All adult patients admitted for septic shock were included and categorized into the following two groups and four subgroups: cancerpatients (solid tumor or hematological malignancy) and non-cancerpatients (immunocompromised or not). Data were collected and compared between the groups. Upon early ICU admission, the decision to forgo life-sustaining therapy (DFLST) or not was made by consultation among hematologists, oncologists, and the patients or their relatives. RESULTS: During the study period, 496 patients were admitted for septic shock: 252 cancerpatients (119 hematological malignancies and 133 solid tumors) and 244 non-cancerpatients. A DFLST was made for 39% of the non-cancerpatients and 52% of the cancerpatients. The 180-day mortality rate among the cancerpatients was 51% and 68% for those with hematological malignancies and solid cancers, respectively. The mortality rate among the non-cancerpatients was 44%. In a multivariate analysis, the performance status, Charlson comorbidity index, simplified acute physiology score 2, sequential organ failure assessment score, and DFLST were independent predictors of 180-day mortality. CONCLUSIONS: Despite early admission to the ICU, the 180-day mortality rate due to septic shock was higher in cancerpatients compared with non-cancerpatients, due to excess mortality in the patients with solid tumors. The long-term prognosis of cancerpatients with septic shock is modulated by their general state, severity of organ failure, and DFLST.
Entities:
Keywords:
Cancer; Intensive care unit; Septic shock
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