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Improved survival of critically ill cancer patients with septic shock
Jérôme Larché1, Elie Azoulay, Fabienne Fieux
1Medical ICU of the Saint-Louis Teaching Hospital and Paris 7 University, Assistance Publique-Hôpitaux de Paris, 1 Av Claude Vellefaux, 75010 Paris, France.
Objective:
To identify predictors of 30-day mortality in critically ill cancer patients with septic shock.
Design:
Retrospective study over a 6-year period.
Setting:
Twelve-bed medical intensive care unit (ICU).
Patients:
Eighty-eight patients (55 men, 33 women) aged 55 (43.5-63) years admitted to the ICU for septic shock.
Interventions:
None.
Measurements And Main Results:
Eighty (90.9%) patients had hematological malignancies and eight (9.1%) had solid tumors; 47 patients (53.4%) were neutropenic, 19 (21.6%) were hematopoietic stem cell transplantation (HSCT) recipients, and 27 (30.7%) were in remission. Microbiologically documented infections were found in 60 (68.2%) patients. The Simplified Acute Physiologic Score II (SAPS II) and Logistic Organ Dysfunction (LOD) scores at ICU admission were 66 (47-89) and 7 (5-10), respectively, and the LOD score on day 3 was 8 (4-10). Sixty-eight (78.1%) patients received invasive mechanical ventilation (MV), 12 (13.6%) noninvasive MV, 22 (25%) dialysis. Thirty-day mortality was 65.5% (57/88). By multivariable analysis, mortality was higher when time to antibiotic treatment was >2 h [odds ratio (OR), 7.05; 95% confidence interval (95% CI), 1.17-42.21] and when DLOD (day 3-day 1 LOD score/day 3 LOD score) was high (OR, 3.47; 95% CI, 1.44-8.39); mortality was lower when admission occurred between 1998 and 2000 (OR, 0.23; 95% CI, 0.05-0.98) and when initial antibiotics were adapted (OR, 0.24; 95% CI, 0.06-0.09).
Conclusions:
Earlier ICU admission and antibiotic treatment of critically ill cancer patients with septic shock is associated with higher 30-day survival. The LOD score change on day 3 as compared to admission is useful for predicting survival.
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