title: Sepsis-Associated Outcomes in Critically Ill Patients with Malignancies.
abstract: BACKGROUND
  Sepsis is a major cause of mortality among critically ill patients with cancer. Information about clinical outcomes and factors associated with increased risk of death in these patients is necessary to help physicians recognize those patients who are most likely to benefit from ICU therapy and identify possible targets for intervention.
  
  
  OBJECTIVE
  In this study, we evaluated cancer patients with sepsis chosen from a multicenter prospective study to characterize their clinical characteristics and to identify independent risk factors associated with hospital mortality.
  
  
  METHODS
  Subgroup analysis of a multicenter prospective cohort study conducted in 28 Brazilian intensive care units (ICUs) to evaluate adult cancer patients with severe sepsis and septic shock. We used logistic regression to identify variables associated with hospital mortality.
  
  
  RESULTS
  Of the 717 patients admitted to the participating ICUs, 268 (37%) had severe sepsis (n = 142, 53%) or septic shock (n = 126, 47%). These patients comprised the population of the present study. The mean score on the third version of the Simplified Acute Physiology Score was 62.9 ± 17.7 points, and the median Sequential Organ Failure Assessment score was 9 (7-12) points. The most frequent sites of infection were the lungs (48%), intraabdominal region (25%), bloodstream as primary infection (19%), and urinary tract (17%). Half of the patients had microbiologically proven infections, and Gram-negative bacteria were the most common pathogens causing sepsis (31%). ICU and hospital mortality rates were 42% and 56%, respectively. In multivariable analysis, the number of acute organ dysfunctions (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16-1.87), hematological malignancies (OR, 2.57; 95% CI, 1.05-6.27), performance status 2-4 (OR, 2.53; 95% CI, 1.44-4.43), and polymicrobial infections (OR, 3.74; 95% CI, 1.52-9.21) were associated with hospital mortality.
  
  
  CONCLUSIONS
  Sepsis is a common cause of critical illness in patients with cancer and remains associated with high mortality. Variables related to underlying malignancy, sepsis severity, and characteristics of infection are associated with a grim prognosis.
authors.affiliation: 1 Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro.
authors.forename: Viviane B L
authors.initials: VB
authors.lastname: Torres
authors.affiliation: 2 Postgraduate Program, National Cancer Institute.|3 Research and Education Institute, Hospital Sírio-Libanês.
authors.forename: Luciano C P
authors.initials: LC
authors.lastname: Azevedo
authors.affiliation: 4 ICU, Pio XII Foundation, Hospital do Câncer de Barretos, Barretos, Brazil.
authors.forename: Ulysses V A
authors.initials: UV
authors.lastname: Silva
authors.affiliation: 5 ICU, A.C. Camargo Cancer Center, and.
authors.forename: Pedro
authors.initials: P
authors.lastname: Caruso
authors.affiliation: 6 Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI), Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.
authors.forename: André P
authors.initials: AP
authors.lastname: Torelly
authors.affiliation: 7 ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: Eliezer
authors.initials: E
authors.lastname: Silva
authors.affiliation: 8 ICU, Hospital Mater Dei, Belo Horizonte, Brazil.
authors.forename: Frederico B
authors.initials: FB
authors.lastname: Carvalho
authors.affiliation: 9 ICU, Clinica São Vicente.
authors.forename: Arthur
authors.initials: A
authors.lastname: Vianna
authors.affiliation: 10 ICU, Hospital de Clinicas de Niteroi, Niteroi, Brazil.
authors.forename: Paulo C P
authors.initials: PC
authors.lastname: Souza
authors.affiliation: 11 ICU, Hospital de Clinicas, Universidade Federal de Pernambuco, Recife, Brazil; and.
authors.forename: Michele M G
authors.initials: MM
authors.lastname: Godoy
authors.affiliation: 12 ICU Hospital São Domingos-São Luís, São Luís MA, Brazil.
authors.forename: José R A
authors.initials: JR
authors.lastname: Azevedo
authors.affiliation: 1 Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro.
authors.forename: Nelson
authors.initials: N
authors.lastname: Spector
authors.affiliation: 13 D'Or Institute for Research and Education (IDOR), and.|14 National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Bozza
authors.affiliation: 1 Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro.|2 Postgraduate Program, National Cancer Institute.|13 D'Or Institute for Research and Education (IDOR), and.
authors.forename: Jorge I F
authors.initials: JI
authors.lastname: Salluh
authors.affiliation: 1 Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro.|2 Postgraduate Program, National Cancer Institute.|13 D'Or Institute for Research and Education (IDOR), and.
authors.forename: Marcio
authors.initials: M
authors.lastname: Soares
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications*; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000175:diagnosis* / Q000401:mortality*
keywords: cancer; infection; intensive care; malignancy; sepsis