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Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies

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Abstract

Objective

To compare the characteristics and outcome of patients with hematological malignancies referred to the ICU with severe sepsis and septic shock who had or had not received recent intravenous chemotherapy, defined as within 3 weeks prior to ICU admission.

Design and setting

Retrospective observational cohort study on prospectively collected data in a medical ICU of a university hospital.

Patients

186 ICU patients with hematological malignancies with severe sepsis or septic shock (2000–2006).

Measurements and results

There were 77 patients admitted with severe sepsis and 109 with septic shock; 91 (49%) had received recent intravenous chemotherapy. Patients with recent chemotherapy more often had a high-grade malignancy and were more often neutropenic, less often had pulmonary infiltrates, and less often required mechanical ventilation. ICU, 28-day, in-hospital, and 6-month mortality rates were 33% vs. 48.4%, 40.7% vs. 57.4%, 45.1% vs. 58.9%, and 50.5% vs. 63.2% in patients with and without recent chemotherapy, respectively. Logistic regression identified four variables independently associated with 28-day mortality: SOFA score at ICU admission, pulmonary site of infection, and fungal infection were associated with worse outcome whereas previous intravenous chemotherapy was protective at borderline significance. After adjustment with a propensity score for recent chemotherapy, chemotherapy was not associated with outcome.

Conclusions

Patients referred to the ICU with severe sepsis and septic shock complicating active chemotherapeutic treatment have better prognosis than commonly perceived.

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Acknowledgements

D.V. is financially supported by a Doctoral Grant from the Special Scientific Research Fund of the Ghent University. None of the authors have financial or other potential conflicts of interest.

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Authors and Affiliations

  1. Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Dominique M. Vandijck, Dominique D. Benoit, Pieter O. Depuydt, Stijn I. Blot, Joke Nollet & Johan M. Decruyenaere

  2. Department of Hematology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Fritz C. Offner, Anna K. Van Tilborgh, Eva Steel & Lucien A. Noens

Authors
  1. Dominique M. Vandijck
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  2. Dominique D. Benoit
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  9. Lucien A. Noens
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  10. Johan M. Decruyenaere
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Correspondence to Dominique M. Vandijck.

Additional information

This article is discussed in the editorial available at: http://dx.doi.org/10.1007/s00134-008-1003-1.

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Vandijck, D.M., Benoit, D.D., Depuydt, P.O. et al. Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. Intensive Care Med 34, 847–855 (2008). https://doi.org/10.1007/s00134-008-1002-2

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  • DOI: https://doi.org/10.1007/s00134-008-1002-2

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