Clinical characteristics and outcomes of critically ill cancer patients with septic shock

• Published in: QJM : An International Journal of Medicine 2011-06, Vol.104 (6), p.505-511
• Main Authors: NAMENDYS-SILVA, S. A, GONZALEZ-HERRERA, M. O, TEXCOCANO-BECERRA, J, HERRERA-GOMEZ, A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cohort Studies; Critical Illness; Emergency and intensive care: infection, septic shock; Female; General aspects; Humans; Intensive care medicine; Intensive Care Units - statistics & numerical data; Male; Medical sciences; Mexico; Middle Aged; Neoplasms - complications; Neoplasms - mortality; Prognosis; Prospective Studies; Risk Factors; Shock, Septic - microbiology; Shock, Septic - mortality
• ISSN: 1460-2725; 1460-2393
• DOI: 10.1093/qjmed/hcq260

To evaluate the clinical characteristics and outcomes of critically ill cancer patients with septic shock. Prospective, observational cohort study. 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. 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%). The variables associated with increased mortality were the degree of organ dysfunction determined by SOFA score at ICU admission and PS≥2.