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


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


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


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.
Vandijck
Dominique M
DM
Department of Intensive Care Medicine, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium. Dominique.Vandijck@UGent.be
Benoit
Dominique D
DD
Depuydt
Pieter O
PO
Offner
Fritz C
FC
Blot
Stijn I
SI
Van Tilborgh
Anna K
AK
Nollet
Joke
J
Steel
Eva
E
Noens
Lucien A
LA
Decruyenaere
Johan M
JM
D000970:Antineoplastic Agents / Q000009:adverse effects*; D001530:Belgium; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects*; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents