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Cancer patients with septic shock: mortality predictors and neutropenia

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Abstract

Goals of work

To study outcome and its predictive factors in cancer patients admitted to the ICU with septic shock, and the implications of neutropenia as a risk factor in this advanced stage of systemic inflammatory response.

Patients and methods

A prospective consecutive observational cohort study was conducted in 73 adults with cancer and septic shock admitted to the ICU at the Cancer Medical Center associated with the University of Buenos Aires.

Main results

The mortality rate from septic shock was 53.4% (95%CI 41.9 to 64.8%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission, the mean number of organ dysfunctions on admission or during the ICU stay, liver dysfunction, respiratory dysfunction, and the need for mechanical ventilation were predictive of mortality in a univariate analysis. Neutropenia was not associated with a worse prognosis in terms of mortality (56%) or mean days of ICU stay (6.64 days) in comparison with nonneutropenic patients (52.1% and 6.8 days) in the univariate analysis. In the logistic regression model only the need for mechanical ventilation and liver dysfunction remained independent predictors of mortality.

Conclusions

Septic shock among cancer patients admitted to the ICU has a mortality rate similar to that reported for mixed populations, and it is particularly increased when hepatic or respiratory dysfunction develop. Neutropenia on admission does not seem to modify outcome.

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References

  1. Azoulay E, Moreau D, Alberti C, et al (2000) Predictors of short-term mortality in critically ill patients with solid malignancies. Intensive Care Med 26:1817–1823

    Article  CAS  PubMed  Google Scholar 

  2. Bellingan G (2000) Leukocytes: friend or foe. Intensive Care Med [Suppl] 26:s111–s118

    Google Scholar 

  3. Blot F, Guiguet M, Nitenberg G, et al (1997) Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures. Eur J Cancer 33:1031–1037

    Article  CAS  PubMed  Google Scholar 

  4. Blot F, Cordonier C, Nitenberg G, et al (2001) Severity of illness scores: are they useful in febrile neutropenic adult patients in hematology wards? Crit Care Med 29:2125–2131

    Article  CAS  PubMed  Google Scholar 

  5. Bogolioubov A, Keefe DL, Groeger JS (2001) Circulatory shock. Crit Care Clin 17:697–719

    CAS  PubMed  Google Scholar 

  6. Boussat S, El’rini T, Dubiez A, et al (2000) Predictive factors of death in primary lung cancer patients on admission to the intensive care unit. Intensive Care Med 26:1811–1816

    Article  CAS  PubMed  Google Scholar 

  7. Boxer L, Dale DC (2003) Neutropenia: causes and consequences. Semin Hematol 39:75–81

    Article  Google Scholar 

  8. Darmon M, Azoulay E, Alberti C, et al (2002) Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients. Intensive Care Med 28:1775–1780

    Article  PubMed  Google Scholar 

  9. Dhainaut JF, Marin N, Mignon A, et al (2000) Hepatic response to sepsis: interaction between coagulation and inflammatory processes. Crit Care Med [Suppl] 29:s42–s47

    Google Scholar 

  10. Groeger JS, Lemeyow S, Price K, Nierman DM, et al (1998) Multicenter outcome study of cancer patients admitted to the intensive care unit: a probability of mortality model. J Clin Oncol 16:761–770

    CAS  PubMed  Google Scholar 

  11. Guiguet M, Blot F, Escudier B, Antoun S, Leclercq B, Nitenberg G (1998) Severity-of-illness scores for neutropenic cancer patients in an intensive care unit: which is the best predictor? Do multiple assessment times improve the predictive value? Crit Care Med 26:488–493

    Article  CAS  PubMed  Google Scholar 

  12. Haj MA, Neilly IJ, Robbie LA, et al (1995) Influence of white blood cells on the fibrinolytic response to sepsis: studies of septic patients with or without severe leucopenia. Br J Haematol 90:541–547

    CAS  PubMed  Google Scholar 

  13. Kress JP, Christenson J, Pohlman AS, et al (1999) Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 160:1957–1961

    CAS  PubMed  Google Scholar 

  14. Kroschinsky FK, Weise M, Illmer T, et al (2002) Outcome and prognostic features of intensive care unit treatment in patients with hematologic malignancies. Intensive Care Med 28:1294–1300

    Article  PubMed  Google Scholar 

  15. Laufe MD, Simon RH, Flint A, et al (1986) Adult respiratory distress syndrome in neutropenic patients. Am J Med 80:1022–1026

    Article  CAS  PubMed  Google Scholar 

  16. Lloyd-Thomas AR, Wright I, Lister TA, et al (1988) Prognosis of patients receiving intensive care for life threatening medical complications of haematologic malignancy. BMJ 296:1025–1029

    CAS  PubMed  Google Scholar 

  17. Luna CM, Videla A, Mattera J, et al (1999) Blood cultures have limited value in predicting severity of illness and as a diagnostic tool in ventilator-associated pneumonia. Chest 116:1075–1084

    Article  CAS  PubMed  Google Scholar 

  18. Marshall JC, Cook DJ, Christou NV, et al (1995) Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23:1638–1652

    Article  CAS  PubMed  Google Scholar 

  19. Massion PB, Dive AM, Doyen C, et al (2002) Prognosis of hematologic malignancies does not predict intensive care unit mortality. Crit Care Med 30:2260–2270

    Article  PubMed  Google Scholar 

  20. Muckart DJJ, Bhagwanjee S (1997) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 25:1789–1795

    Article  CAS  PubMed  Google Scholar 

  21. Neilly IJ, Copland M, Haj M, et al (1995) Plasma nitrate concentrations in neutropenic and non-neutropenic patients with suspected septicaemia. Br J Haematol 89:199–202

    CAS  PubMed  Google Scholar 

  22. Ognibene FP, Martin SE, Parkers MM, et al (1986) Adult respiratory distress syndrome in patients with severe neutropenia. N Engl J Med 315:547–551

    CAS  PubMed  Google Scholar 

  23. Price KJ, Thall PF, Kish SK, et al (1998) Prognostic indicators for blood and marrow transplant patients admitted to an intensive care unit. Am J Respir Crit Care Med 158:876–884

    CAS  PubMed  Google Scholar 

  24. Rangel-Frausto MS, Pittet D, Costigan M, et al (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273:117–123

    Article  CAS  PubMed  Google Scholar 

  25. Regazzoni CJ, Khoury M, Irrazabal C, et al (2003) Neutropenia and the development of the systemic inflammatory response syndrome. Intensive Care Med 29:135–138

    PubMed  Google Scholar 

  26. Schuster DP, Marion JM (1983) Precedents for meaningful recovery during treatment in a medical intensive care unit. Am J Med 75:402–408

    Article  CAS  PubMed  Google Scholar 

  27. Sculier JP, Paesmans M, Markiewicz E, Berghmans T (2000) Scoring systems in cancer patients admitted for an acute complication in a medical intensive care unit. Crit Care Med 28:2786–2792

    Article  CAS  PubMed  Google Scholar 

  28. Staudinger T, Stoiser B, Müllner M, et al (2000) Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med 28:1322–1328

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires, Argentina

    Carlos J. Regazzoni, Carlos M. Luna & Juan J. Poderoso

  2. Pulmonary Division, Hospital de Clínicas “José de San Martín”, Universidad de Buenos Aires, Argentina

    Carlos M. Luna

  3. Intensive Care Unit, Instituto Alexander Fleming, Buenos Aires, Argentina

    Célica Irrazabal

  4. 5th Cátedra de Medicina, Hospital de Clínicas “José de San Martín”, Av. Córdoba 2351, 1120, Buenos Aires, Argentina

    Carlos J. Regazzoni

Authors
  1. Carlos J. Regazzoni
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  2. Célica Irrazabal
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  3. Carlos M. Luna
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  4. Juan J. Poderoso
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Correspondence to Carlos J. Regazzoni.

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Regazzoni, C.J., Irrazabal, C., Luna, C.M. et al. Cancer patients with septic shock: mortality predictors and neutropenia. Support Care Cancer 12, 833–839 (2004). https://doi.org/10.1007/s00520-004-0667-5

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  • DOI: https://doi.org/10.1007/s00520-004-0667-5

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