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Clinical characteristics and outcomes of critically ill cancer patients with septic shock
S A Ñamendys-Silva1, M O González-Herrera, J Texcocano-Becerra
1Department of Critical Care Medicine, Instituto Nacional de Cancerología, México. Av. San Fernando No. 22, Col. Sección XVI, Delegación Tlalpan, 14080, México City, Mexico. snamendys@incan.edu.mx
Objective:
To evaluate the clinical characteristics and outcomes of critically ill cancer patients with septic shock.
Design:
Prospective, observational cohort study.
Methods:
Medical-surgical intensive care unit (ICU) at the Instituto Nacional de Cancerología located in Mexico City from January 2008 to February 2010. There were no interventions. Eighty-two consecutive cancer patients with septic shock aged over 18 years were prospectively included and evaluated.
Results:
During the study period, 620 critically ill cancer patients were admitted to ICU. Ninety-four patients were evaluated for septic shock at the request of ward onco-hematologists or surgeon oncologist responsible for the patient. After being evaluated by the intensivists, 82 patients were admitted to the ICU. Of the 82 patients, 56 (68.3%) had solid tumours and 26 (31.7%) had hematological malignancy. The most frequent sites of infection were: abdominal (57.3%) and respiratory (35.8%). Cultures were positive in 41 (50%) patients. The 63.4% of the patients had three or more organ dysfunctions on the day of their admission to the ICU. Cox multivariate analysis identified the Sequential Organ Failure Assessment (SOFA) score [hazard ratio (HR): 1.11; 95% confidence interval (95% CI): 1.02-1.19, P=0.008) and performance status (PS)≥2 (HR: 1.84; 95% CI: 1.03-3.29, P=0.040) as independent predictors of death to 3 months. The ICU mortality rate was 41.5% (95% CI: 31-52%).
Conclusion:
The variables associated with increased mortality were the degree of organ dysfunction determined by SOFA score at ICU admission and PS≥2.
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