title: Impact of case volume on survival of septic shock in patients with malignancies.
abstract: OBJECTIVE
  Septic shock is a frequent and severe complication in the course of malignancies. In a large multicenter cohort of septic shock patients with hematologic malignancies and solid tumors, we assessed the temporal trend in survival and the prognostic factors, with particular emphasis on case volume.
  
  
  METHODS
  A 12-yr multicenter retrospective cohort study of prospectively collected data.
  
  
  METHODS
  Cancer patients with septic shock were selected over a 12-yr period (1997-2008) from a French regional database (CUB-Réa). The following variables were extracted: demographic characteristics, type of malignancy, characteristics of infection, severity-of-illness score (Simplified Acute Physiology Score II), organ failure supports, and vital status. For each unit, a running mean annual volume of admissions was calculated for the purpose of categorization into volume tertiles. Prognostic factors were analyzed by a conditional multivariate logistic model after matching on a propensity score of being admitted to a high-volume unit and on the year of admission.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 3,437 patients were included in the study. The intensive care unit mortality rate dramatically dropped over time (from 70.4% in 1997 to 52.5% in 2008, relative decrease 25.4%, p < .001). Participating units were distributed into low-volume (< five patients per year), medium-volume (five to 12 patients per year), and high-volume (≥ 13 patients per year) tertiles. A medical cause for intensive care unit admission, Simplified Acute Physiology Score II, invasive mechanical ventilation, renal replacement therapy, fungal infections, and unknown microorganism were identified as poor prognostic factors. Case volume demonstrated a strong influence on survival, admission in a high-volume unit being associated with a marked decrease in mortality as compared to low-volume units (adjusted odds ratio 0.63; 95% confidence interval [0.46-0.87], p = .002).
  
  
  CONCLUSIONS
  Survival of septic shock patients with malignancies markedly increased over the recent years. Furthermore, we identified case volume as a major prognostic factor in this setting.
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Réanimation Médicale, AP-HP, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zuber
authors.forename: Thi-Chien
authors.initials: TC
authors.lastname: Tran
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.forename: David
authors.initials: D
authors.lastname: Grimaldi
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
mesh_terms: D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D000091402:Prohibitins; D012189:Retrospective Studies; D012772:Shock, Septic / Q000401:mortality*; D016896:Treatment Outcome