title: Predictive factors of septic shock and mortality in neutropenic patients.
abstract: Neutropenia is a major risk factor for developing a serious infection. Bacteremia still causes significant mortality among neutropenic patients with cancer. The purpose of this study was to identify risk factors for septic shock and for mortality in neutropenic patients with leukemia and bacteremia. Consecutive samples from 20 patients with acute myeloid leukemia and bacteremia were studied during a 1 year period (January-December 2003). All patients received empirical antibiotic therapies for febrile episodes using ceftazidime plus amikacin. About 110 neutropenic febrile episodes were noted: clinically documented 14.54%, microbiologically documented 16.36% and fever of unknown origin 69.09%. Gram-negative organism caused eight febrile episodes: Pseudomonas (5), Klebsiella (3). Gram-positive organism caused 10 episodes: Staphylococcus (6), Streptococci (2), Enterococci (2). Pulmonary infection accounted for 25% of clinically documented infections. About 14 of the 110 febrile episodes were associated with septic shock causing mortality in 7 patients. In a univariate analysis variables associated with septic shock were: pulmonary infection (OR = 17, p = 0.001), serum bicarbonate < 17 mmol/l (OR = 68, p < 0.001) and serum lactate >3 mmol/l (OR = 62, p < 0.001). Variables associated with mortality were: pulmonary infection (OR = 83, p < 0.001) and serum bicarbonate < 17 mmol/l (OR = 61, p < 0.001). In a multivariate analysis two variables were associated with septic shock: pulmonary infection (OR = 5, p = 0.043) and serum lactate >3 mmol/l (OR = 10, p = 0.003). An elevated serum lactate (>3 mmol/l) and low serum bicarbonate ( < 17 mmol/l) at the onset of bacteremia are useful biomarkers in predicting septic shock and mortality in neutropenic patients.
authors.affiliation: Department of Hematology Place du gouvernement la Kasbah, Aziza Othmana University Hospital, Tunis, Tunisia. ramzi.jed@voila.fr
authors.forename: Jeddi
authors.initials: J
authors.lastname: Ramzi
authors.forename: Zarrouk
authors.initials: Z
authors.lastname: Mohamed
authors.forename: Benabdennebi
authors.initials: B
authors.lastname: Yosr
authors.forename: Kacem
authors.initials: K
authors.lastname: Karima
authors.forename: Benlakhal
authors.initials: B
authors.lastname: Raihane
authors.forename: Aissaoui
authors.initials: A
authors.lastname: Lamia
authors.forename: Ben Abid
authors.initials: BA
authors.lastname: Hela
authors.forename: Belhadjali
authors.initials: B
authors.lastname: Zaher
authors.forename: Meddeb
authors.initials: M
authors.lastname: Balkis
mesh_terms: D000328:Adult; D016470:Bacteremia; D001419:Bacteria / Q000302:isolation & purification; D001639:Bicarbonates / Q000097:blood; D005260:Female; D005334:Fever; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000175:diagnosis* / Q000401:mortality; D018410:Pneumonia, Bacterial; D011379:Prognosis; D012307:Risk Factors; D012772:Shock, Septic / Q000175:diagnosis* / Q000401:mortality
chemical_list: D001639:Bicarbonates; D019344:Lactic Acid