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Long-term prognosis of septic shock in cancer patients

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Abstract

Objectives

In the last decades, the number of cancer patients admitted in intensive care units (ICUs) for septic shock has dramatically increased. However, prognosis data remain scarce.

Methods

To assess the 180-day mortality rate in cancer patients admitted to the ICU for septic shock, a 5-year prospective study was performed. All adult patients admitted for septic shock were included and categorized into the following two groups and four subgroups: cancer patients (solid tumor or hematological malignancy) and non-cancer patients (immunocompromised or not). Data were collected and compared between the groups. Upon early ICU admission, the decision to forgo life-sustaining therapy (DFLST) or not was made by consultation among hematologists, oncologists, and the patients or their relatives.

Results

During the study period, 496 patients were admitted for septic shock: 252 cancer patients (119 hematological malignancies and 133 solid tumors) and 244 non-cancer patients. A DFLST was made for 39% of the non-cancer patients and 52% of the cancer patients. The 180-day mortality rate among the cancer patients was 51% and 68% for those with hematological malignancies and solid cancers, respectively. The mortality rate among the non-cancer patients was 44%. In a multivariate analysis, the performance status, Charlson comorbidity index, simplified acute physiology score 2, sequential organ failure assessment score, and DFLST were independent predictors of 180-day mortality.

Conclusions

Despite early admission to the ICU, the 180-day mortality rate due to septic shock was higher in cancer patients compared with non-cancer patients, due to excess mortality in the patients with solid tumors. The long-term prognosis of cancer patients with septic shock is modulated by their general state, severity of organ failure, and DFLST.

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Acknowledgments

The authors thank Mojgan HESSAMFAR, MD, for her kind contribution to realize the statistical analysis.

Author information

FC and NI designed the study. FC, NI, and MD collected demographic, clinical, and paraclinical data. TL and NM regularly treated hematological patients of the study. AD and AR regularly treated oncological patients of the study. FC, NI, GM, and OG regularly treated septic shocks in ICU. FC performed the statistical analysis. FC, MD, and NI wrote the article. All authors reviewed and approved the article.

Correspondence to Nahéma Issa.

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Patients were informed of the anonymous use of their medical data for clinical research in accordance with French legal standards (CNIL no. 2009055).

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The authors declare that they have no conflict of interest.

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Camou, F., Didier, M., Leguay, T. et al. Long-term prognosis of septic shock in cancer patients. Support Care Cancer (2019). https://doi.org/10.1007/s00520-019-04937-4

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Keywords

  • Septic shock
  • Cancer
  • Intensive care unit