PURPOSE: To analyze our clinical experience with the use of drotrecogin alfa activated (DrotAA) in patients undergoing active cancer treatment who developed septic shock.
METHODS: Retrospective analysis of the medical records of all cancer patients who were treated with DrotAA for septic shock and were admitted to the ICU at a tertiary care cancer center between January 2004 and December 2006. The following variables were collected: demographics, admitting service, severity of illness as measured by Mortality Probability Model II score (MPM-II) on ICU admission and APACHE II score at the time of DrotAA infusion, use of vasopressors (VP) and mechanical ventilation (MV), duration of DrotAA infusion, reasons for DrotAA discontinuation, and ICU and hospital length of stay (LOS) and mortality.
RESULTS: Of 1390 patient admissions to the ICU during the 3-year period, 11 (0.8%) were admitted with septic shock and received DrotAA. The mean age was 60 years and 55% were male. Eight were medical cancer patients and 3 were postoperative surgical cancer patients. The mean MPM-II score was 53% and the mean APACHE II score was 34. All 11 patients received VP and MV. Four patients completed the 96-hour infusion while 7 patients did not (1 patient: 73 hours and 6 patients: 2 to 14 hours). The reasons for incomplete administration of DrotAA infusion were: severe coagulopathy [n=1], need for anticoagulation [n=1], sudden hemorrhage [n=1], DNR [n=2], and death [n=2]). The mean ICU and hospital LOS were 21 and 39 days, respectively. The ICU mortality rate was 64% while the combined ICU and hospital mortality rate was 82%.
CONCLUSION: DrotAA was rarely administered in patients undergoing active cancer treatment who developed septic shock. The vast majority of patients did not complete the recommended 96-hour infusion and the mortality rate was high.
CLINICAL IMPLICATIONS: The high rate of discontinuation of DrotAA infusion was unexpected and suggests a need for careful patient selection and possibly reassessment of appropriate eligibility criteria in this population.
DISCLOSURE: Kashif Hassan, No Financial Disclosure Information; No Product/Research Disclosure Information