Sepsis is a common complication in cancer patients. The aim in the present study was identify factors associated with mortality in critically ill cancer patients with septic shock (SS).
Retrospective observational study. Interventions: None. Setting: Six-medical-surgical oncological Intensive Care Unit (ICU). Of 264 patients with cancer admitted to the ICU from January to October of 2007, 51 patients had SS. Values are expressed as mean and standard deviation for continuous variables or percentage for categorical variables. Univariate and multivariate logistic regression were used to identify factors associated with ICU mortality. The patients received treatment following the internationally accepted guidelines; The Surviving Sepsis Campaign.
Twenty-eight were women (54.9%), with median age of 44 years, all patients, required mechanical ventilation, the median duration was 3.54 ± 4.25 days and the median length of stay in the ICU was 4.62 ± 5.51 days. The most common site of infection was the lung (26/51%). Thirty six patients (70.6%) had solid tumors and fifteen (29.4%) had hematological malignancies. The cancer status: 49% were newly diagnosed, 25.5% recurrent or progression, 23.5% no response to treatment and 2% complete remission of disease. The median SOFA score was 9.5 ± 3.5. The 88.2% of the patients had three or more organ dysfunctions (OD) on day of admission to ICU. By multivariable analysis, mortality was higher when the levels of positive end expiratory pressure (PEEP) were > 8 cmH2O (odds ratio: 9.73, 95% confidence interval: 1.42–66.62, p = 0.020)(Goodness of fit, Hosmer-Lemeshow, X2=5.59, p = 0.692). The mortality in the ICU was 60.7% and increased with the number of organs failing, especially when three or more organs failed (66.6%).
Cancer patients admitted to the ICU with SS have a mortality rate similar to that reported for mixed populations, and it is particularly increased with levels of PEEP > 8 cmH2O.
The detection of OD over the first hours or days of treatment could be simple and objective tool for to identify patients who should be admitted more early to ICU.
Silvio Namendys-Silva, No Financial Disclosure Information; No Product/Research Disclosure Information