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Improved survival of critically ill cancer patients with septic shock

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Abstract

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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Authors and Affiliations

  1. Medical ICU of the Saint-Louis Teaching Hospital and Paris 7 University, Assistance Publique-Hôpitaux de Paris, 1 Av Claude Vellefaux, 75010 , Paris, France

    Jérôme Larché, Élie Azoulay, Fabienne Fieux, Laurent Mesnard, Delphine Moreau, Guillaume Thiery, Michaël Darmon, Jean-Roger Le Gall & Benoît Schlemmer

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  1. Jérôme Larché
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  2. Élie Azoulay
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  3. Fabienne Fieux
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  4. Laurent Mesnard
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  5. Delphine Moreau
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  6. Guillaume Thiery
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  7. Michaël Darmon
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  8. Jean-Roger Le Gall
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  9. Benoît Schlemmer
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Correspondence to Élie Azoulay.

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Larché, J., Azoulay, É., Fieux, F. et al. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med 29, 1688–1695 (2003). https://doi.org/10.1007/s00134-003-1957-y

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  • DOI: https://doi.org/10.1007/s00134-003-1957-y

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