Outcomes in critically ill cancer patients with septic shock of pulmonary origin.
Increased therapeutic intensity has translated into better survival at a price of infectious and toxic life-threatening complications, chiefly affecting the lungs. Yet, no study specifically evaluated outcomes in cancer patients admitted to the intensive care unit (ICU) for septic shock of pulmonary origin. This is a multicenter cohort study of cancer patients admitted to the ICU for septic shock and pneumonia between 1998 and 2008. Independent determinants of hospital mortality were assessed using a multivariate logistic regression model. Prognostic impact of persistence or acquisition of organ failures was evaluated by survival conditional probabilities. During the 10-year study period, 218 patients were included. Hematologic malignancy (mostly non-Hodgkin lymphoma and acute leukemia) affected 84%, and solid tumors (mostly lung cancer) affected 16% of patients. Chemotherapy was recently administered in 89% of patients, and 24.5% of patients were recipients of hematopoietic stem cell transplantation (35 autologous, 18 allogeneic). At the time of ICU admission, 60% of patients were in partial or complete remission. All patients received vasopressors; invasive mechanical ventilation (MV) was needed in 78.4% and dialysis in 30% of patients. Intensive care unit and hospital mortality rates were 56.4% and 62.4%, respectively. Independent risk factors for hospital mortality were age older than 60 years, time between first symptoms and ICU admission, use of invasive MV, need for invasive MV after use of noninvasive ventilation, and coma. Analysis of survival probability showed that there was no temporal threshold after which persistence or gain of organ dysfunction indicated no hope for survival. Survival in cancer patients with septic shock from pulmonary origin is substantial, even when organ dysfunctions are not rapidly reversible. Delayed ICU management is an independent predictor of death. Studies assessing survival benefits from early ICU management are warranted.
Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Paris, France. elie.azoulay@sls.aphp.fr
Etienne
E
de Montmollin
Yacine
Y
Tandjaoui-Lambiotte
Mattieu
M
Legrand
Jérôme
J
Lambert
Djamel
D
Mokart
Achille
A
Kouatchet
Virginie
V
Lemiale
Frédéric
F
Pène
Fabrice
F
Bruneel
François
F
Vincent
Julien
J
Mayaux
Sylvie
S
Chevret
Elie
E
Azoulay
D000367:Age Factors; D000368:Aged; D003422:Critical Care / Q000379:methods; D061345:Early Medical Intervention / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D011014:Pneumonia / Q000150:complications* / Q000628:therapy; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods; D012772:Shock, Septic / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome