Authors (including presenting author) :
Man MY (1), Shum HP (1), Lam SM (1), Li KC (1), Yan WW (1)
Affiliation :
(1)Department of Intensive care, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR
Introduction :
Sepsis is an important cause of mortality and morbidity among critically ill patients with underlying malignancy.
Objectives :
(1) To evaluates the clinical characteristics and outcomes of critically ill septic cancer patients in comparison to those without underlying malignancy
(2) To identify predictors of 30-day all-cause mortality
Methodology :
Patients with a primary diagnosis of sepsis who were admitted to the intensive care unit (ICU) of the Pamela Youde Nethersole Eastern Hospital from 1 Jan 2010 to 30 Apr 2019 were recruited. Those without significant bacterial culture findings within 72hrs of ICU admission were excluded. Patients were followed till 365 days from ICU admission or death, whichever occurred earlier. Demographics, diagnosis, clinical characteristics, laboratory parameter and outcome data were analyzed. Those with underlying active malignancy were matched with those without malignancy using propensity score matching method based on their severity of organ failure (defined by the sequential organ failure assessment SOFA score) and septic source.
Result & Outcome :
A total of 263 patients with underlying active malignancy were matched with 259 patients without malignancy. The source of sepsis, SOFA score and APACHE IV acute physiology score showed no significant difference between groups. Pulmonary, gastrointestinal and hepatobiliary sepsis was the most commonly encountered septic sources. Those with malignancy had higher APACHE IV score (89 vs. 83) and APACHE IV predicted risk of death (0.45 vs. 0.32), lower albumin (22.1 vs 24.4), neutrophil count (6.0 vs. 9.3), haemoglobin (8.0 vs. 9.8), platelet count (113 vs. 133), less use of mechanical ventilation (35.7 vs. 45.9%), renal replacement therapy (22.1 vs. 28.2%) and vasopressor support (66.2 vs. 74.9%), higher 30-day (34.2 vs. 24.3%), ICU (22.4 vs. 18.9%), hospital (41.1 vs. 27.4%) and 1-year (62.4 vs. 36.7%) mortality when compared with those without malignancy. Cox regression analysis showed that only APACHE IV score and the presence of pulmonary sepsis independently predicted 30-day mortality, while APACHE IV score, age, haemoglobin level, presence of urosepsis and hepatobiliary sepsis predicted 1-year mortality.
Disease severity and the presence of pulmonary sepsis, but not underlying malignancy, predicated short-term mortality among those critically ill septic patients. ICU admission for those patients with malignancy but good performance status can be considered if resources allow, especially for gastrointestinal and urological sepsis.
