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Sepsis and Septic Shock in Cancer Patients

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Oncologic Critical Care

Abstract

Cancer is one of the most common comorbid medical conditions present among sepsis patients. Although sepsis-related mortality rates in cancer patients are decreasing over time, similar to the general population, their incidence and mortality rates still remain unacceptably high. Because of their underlying cancer diagnoses and immunologic states, cancer patients require special attention and have unique considerations for the treatment and management of sepsis. In addition, new and emerging cancer therapeutics bring additional challenges in the management of sepsis in cancer patients. This chapter begins with a discussion regarding the current dynamics related to sepsis terminology and then covers the prevailing understanding of sepsis epidemiology, etiology, and pathophysiology. Finally, the clinical aspects of diagnosis, management, and prognosis are presented, which are largely based on studies in the general population and have been extrapolated for the cancer patient.

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References

  1. Angus DC, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.

    Article  CAS  Google Scholar 

  2. Angus DC, et al. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe investigators. Intensive Care Med. 2015;41:1549–60.

    Article  CAS  Google Scholar 

  3. Asfar P, et al. High versus low blood-pressure target in patients with septic shock. NEJM. 2014;370:1583–93.

    Article  CAS  Google Scholar 

  4. Azoulay E, et al. Dexamethasone in patients with acute lung injury from acute monocytic leukaemia. Eur Respir J. 2012;39(3):648–53.

    Article  CAS  Google Scholar 

  5. Bone RC, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):644–55.

    Google Scholar 

  6. Bone RC, et al. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest. 1997;112:235–43.

    Article  CAS  Google Scholar 

  7. Carniero AH, Povoa P, Gomes JA. Dear Sepsis-3, we are sorry to say that we don’t like you. Rev Bras Ter Intensiva. 2017;29(1):4–8.

    Google Scholar 

  8. Chan T, Gu F. Early diagnosis of sepsis using serum biomarkers. Expert Rev Mol Diagn. 2011;11(5):487–96.

    Article  CAS  Google Scholar 

  9. Danai PA, et al. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129(6):1432–40.

    Article  Google Scholar 

  10. De Backer D, et al. Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence. 2014;5(1):73–9.

    Article  Google Scholar 

  11. Dellinger RP, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32(3):858–73.

    Article  Google Scholar 

  12. Fox AC, et al. Cancer causes increased mortality and is associated with altered apoptosis in murine sepsis. Crit Care Med. 2010;38(3):886–93.

    Article  Google Scholar 

  13. Freifeld AG, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010;52(4):e56–93.

    Article  Google Scholar 

  14. Gu WJ, et al. The effect of goal-directed therapy on mortality in patients with sepsis – earlier is better: a meta-analysis of randomized controlled trials. Crit Care. 2014;18(5):570.

    Article  Google Scholar 

  15. Gu WJ, Zhang Z, Bakker J. Early lactate clearance-guided therapy in patients with sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials. Intensive Care Med. 2015;41(10):1862–3.

    Article  Google Scholar 

  16. Henriquez-Camacho C, Losa J. Biomarkers for sepsis. Biomed Res Int. 2014;2014:547818. https://doi.org/10.1155/2014/547818. 6 pages.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Holland T, Fowler VG, Shelburne SA. Invasive gram-positive bacterial infection in cancer patients. Clin Infect Dis. 2014;59(5):S331–4.

    Article  Google Scholar 

  18. Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003;348(2):138–50.

    Article  CAS  Google Scholar 

  19. Larché J, et al. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med. 2003;29(10):1688–95.

    Article  Google Scholar 

  20. Legrand M, et al. Survival in neutropenic patients with severe sepsis or septic shock. Crit Care Med. 2012;40:43–9.

    Article  Google Scholar 

  21. Levy MM, et al. The surviving sepsis campaign bundle: 2018 update. Crit Care Med. 2018;46(6):997–1000.

    Article  Google Scholar 

  22. Machado FR, et al. Sepsis 3 from the perspective of clinicians and quality improvement initiatives. J Crit Care. 2017;40:315–7.

    Article  Google Scholar 

  23. Maheshwari K, et al. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Intensive Care Med. 2018; https://doi.org/10.1007/s00134-018-5218-5. [Epub ahead of print]. PMID: 29872882.

    Article  Google Scholar 

  24. Malik I, et al. Sepsis and acute myeloid leukemia: a population-level study of comparative outcomes of patients discharged from Texas hospitals. Clin Lymphoma Myeloma Leuk. 2017;17(12):e27–32.

    Article  Google Scholar 

  25. Mancini N, Clerici D, Diotti R, et al. Molecular diagnosis of sepsis in neutropenic patients with haematological malignancies. J Med Microbiol. 2008;57(5):601–4.

    Article  Google Scholar 

  26. Martin GS, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–54.

    Article  Google Scholar 

  27. Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34:15–21.

    Article  Google Scholar 

  28. Medam S, et al. Risk factors for death in septic shock: a retrospective cohort study comparing trauma and non-trauma patients. Medicine. 2017;96(50):e9241.

    Article  Google Scholar 

  29. Nazer L, et al. Evaluating the effectiveness and safety of hydrocortisone therapy in cancer patients with septic shock. J Oncol Pharm. 2015;21(4):274–9.

    Article  CAS  Google Scholar 

  30. Péne F, et al. Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med. 2008;36:690–6.

    Article  Google Scholar 

  31. Reinhart K, Meisner M, Brunkhorst FM. Markers for sepsis diagnosis: what is useful? Crit Care Clin. 2006;22(3):503–19.

    Article  CAS  Google Scholar 

  32. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304.

    Article  Google Scholar 

  33. Rosolem MM, Rabello LS, Lisboa T, et al. Critically ill patients with cancer and sepsis: clinical course and prognostic factors. J Crit Care. 2012;27(3):301–7.

    Article  Google Scholar 

  34. Safdar A, Rolston KV. Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis. 2007;45(12):1602–9.

    Article  Google Scholar 

  35. Safdar A, Armstrong D. Infectious morbidity in critically ill patients with cancer. Crit Care Clin. 2001;17:531–70.

    Article  CAS  Google Scholar 

  36. Seymour CW, et al. Assessment of clinical criteria for sepsis for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762–74.

    Article  CAS  Google Scholar 

  37. Singer M, et al. The Third International Consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.

    Article  CAS  Google Scholar 

  38. Song JE, et al. Mortality risk factors for patients with septic shock after implementation of the surviving sepsis campaign bundles. Infect Chemother. 2016;48(3):199–208.

    Article  CAS  Google Scholar 

  39. Taccone FS, et al. Characteristics and outcomes of cancer patients in European ICUs. Crit Care. 2009;13:R15.

    Article  Google Scholar 

  40. van der Poll T, Opal SM. Host-pathogen interactions in sepsis. Lancet Infect Dis. 2008;8(1):32–43.

    Article  Google Scholar 

  41. Vincent J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323–9.

    Article  CAS  Google Scholar 

  42. Wallace SK, et al. Two decades of ICU utilization and hospital outcomes in a comprehensive cancer center. Crit Care Med. 2016;44(5):926–33.

    Article  Google Scholar 

  43. Williams MD, et al. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care. 2004;8(5):R291–8.

    Article  Google Scholar 

  44. Xia R, Wang D. Intensive care unit prognostic factors in critically ill patients with advanced solid tumors: a 3-year retrospective study. BMC Cancer. 2016;16:188.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Imrana Malik & Joseph L. Nates

Authors
  1. Imrana Malik
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  2. Joseph L. Nates
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Correspondence to Imrana Malik .

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Editors and Affiliations

  1. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Joseph L. Nates

  2. Department of Critical Care, University of Texas MD Anderson Cancer C Department of Critical Care, Houston, TX, USA

    Kristen J. Price

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Malik, I., Nates, J.L. (2019). Sepsis and Septic Shock in Cancer Patients. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74698-2_119-1

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  • DOI: https://doi.org/10.1007/978-3-319-74698-2_119-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74698-2

  • Online ISBN: 978-3-319-74698-2

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