Outcomes and Predictors of 28-Day Mortality in Patients With Solid Tumors and Septic Shock Defined by Third International Consensus Definitions for Sepsis and Septic Shock Criteria.
ICU
cancer
complications
critical care
mortality
sepsis
septic shock
solid tumors
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
22
09
2021
revised:
27
04
2022
accepted:
16
05
2022
pubmed:
2
6
2022
medline:
10
11
2022
entrez:
1
6
2022
Statut:
ppublish
Résumé
Data assessing outcomes of patients with solid tumors demonstrating septic shock using the Third International Consensus Definitions for Sepsis and Septic Shock are scarce. What are the independent predictors of 28-day mortality in critically ill adults with solid tumors and septic shock? Cohort of solid tumor patients admitted to the ICU with septic shock. Demographic and clinical characteristics were gathered from the electronic health records. We developed a reduced multivariate logistics regression model to identify independent predictors of 28-day mortality and used Kaplan-Meier plots to assess survival. A total of 271 patients were included. The median age was 62 years (range, 19-94 years); 57.2% were men and 53.5% were White. The most common underlying malignancies were lung (19.2%), breast (7.7%), pancreatic (7.7%), and colorectal (7.4%) cancers. Most patients (84.5%) harbored metastatic disease. Twenty-eight days after ICU admission, 188 patients (69.4%) had died. Nonsurvivors showed a higher rate of advanced cancer, longer hospital stays before ICU admission, and higher Sequential Organ Failure Assessment scores at admission and throughout the ICU stay (P < .001 for all). The multivariate analysis identified metastatic disease (OR, 3.17; 95% CI, 1.43-7.03), respiratory failure (OR, 2.34; 95% CI, 1.15-4.74), elevated lactate levels (OR, 3.19; 95% CI, 1.90-5.36), and Eastern Cooperative Oncology Group performance scores of 3 or 4 (OR, 2.72; 95% CI, 1.33-5.57) as independent predictors of 28-day mortality. Only 38 patients (14%) were discharged home without medical assistance. The 28-day mortality rate of patients with solid tumors and septic shock was considerably high. Factors associated with worse survival included advanced oncologic disease, poor performance status, high lactate level, and concomitant acute respiratory failure. Early goals-of-care discussions should be considered for frail patients with septic shock and advanced metastatic disease without denying access to the appropriate level of care.
Sections du résumé
BACKGROUND
Data assessing outcomes of patients with solid tumors demonstrating septic shock using the Third International Consensus Definitions for Sepsis and Septic Shock are scarce.
RESEARCH QUESTION
What are the independent predictors of 28-day mortality in critically ill adults with solid tumors and septic shock?
STUDY DESIGN AND METHODS
Cohort of solid tumor patients admitted to the ICU with septic shock. Demographic and clinical characteristics were gathered from the electronic health records. We developed a reduced multivariate logistics regression model to identify independent predictors of 28-day mortality and used Kaplan-Meier plots to assess survival.
RESULTS
A total of 271 patients were included. The median age was 62 years (range, 19-94 years); 57.2% were men and 53.5% were White. The most common underlying malignancies were lung (19.2%), breast (7.7%), pancreatic (7.7%), and colorectal (7.4%) cancers. Most patients (84.5%) harbored metastatic disease. Twenty-eight days after ICU admission, 188 patients (69.4%) had died. Nonsurvivors showed a higher rate of advanced cancer, longer hospital stays before ICU admission, and higher Sequential Organ Failure Assessment scores at admission and throughout the ICU stay (P < .001 for all). The multivariate analysis identified metastatic disease (OR, 3.17; 95% CI, 1.43-7.03), respiratory failure (OR, 2.34; 95% CI, 1.15-4.74), elevated lactate levels (OR, 3.19; 95% CI, 1.90-5.36), and Eastern Cooperative Oncology Group performance scores of 3 or 4 (OR, 2.72; 95% CI, 1.33-5.57) as independent predictors of 28-day mortality. Only 38 patients (14%) were discharged home without medical assistance.
INTERPRETATION
The 28-day mortality rate of patients with solid tumors and septic shock was considerably high. Factors associated with worse survival included advanced oncologic disease, poor performance status, high lactate level, and concomitant acute respiratory failure. Early goals-of-care discussions should be considered for frail patients with septic shock and advanced metastatic disease without denying access to the appropriate level of care.
Identifiants
pubmed: 35644244
pii: S0012-3692(22)01044-3
doi: 10.1016/j.chest.2022.05.017
pmc: PMC9808606
pii:
doi:
Substances chimiques
Lactic Acid
33X04XA5AT
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1063-1073Subventions
Organisme : NCI NIH HHS
ID : P30 CA016672
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
Références
Lancet. 2017 Sep 16;390(10100):1151-1210
pubmed: 28919116
JAMA. 2021 May 4;325(17):1731-1743
pubmed: 33764378
Hepatol Res. 2013 Mar;43(3):255-66
pubmed: 22971102
Cancer Med. 2015 Jul;4(7):966-76
pubmed: 25891471
Crit Care Med. 2020 Mar;48(3):276-288
pubmed: 32058366
Carcinogenesis. 2017 Feb 1;38(2):119-133
pubmed: 27993896
Front Med (Lausanne). 2021 Apr 26;8:603275
pubmed: 33981712
Crit Care Med. 2016 May;44(5):926-33
pubmed: 26765498
J Intensive Care Med. 2021 Mar;36(3):255-261
pubmed: 31868072
Cancers (Basel). 2021 Feb 06;13(4):
pubmed: 33562125
Ann Am Thorac Soc. 2015 Aug;12(8):1185-92
pubmed: 26086679
Crit Care Med. 2018 Dec;46(12):1889-1897
pubmed: 30048332
Crit Care Med. 2020 Mar;48(3):302-318
pubmed: 32058368
Crit Care Med. 2012 Jan;40(1):43-9
pubmed: 21926615
Crit Care Med. 2020 Mar;48(3):289-301
pubmed: 32058367
Intensive Care Med. 2021 Feb;47(2):170-179
pubmed: 32770267
JAMA. 2016 Feb 23;315(8):801-10
pubmed: 26903338
J Clin Oncol. 2013 Aug 1;31(22):2810-8
pubmed: 23752112
Intensive Care Med. 2019 Jul;45(7):977-987
pubmed: 31143998
Intensive Care Med. 2016 Jan;42(1):82-92
pubmed: 26464393
Crit Care Med. 2012 Jan;40(1):55-62
pubmed: 21926606
CA Cancer J Clin. 2020 Jan;70(1):7-30
pubmed: 31912902
BMJ Open. 2021 Feb 16;11(2):e038349
pubmed: 33593761
Crit Care. 2018 Dec 4;22(1):326
pubmed: 30514339
Intensive Care Med. 2019 Jan;45(1):82-85
pubmed: 29754310
BMC Cancer. 2021 Jun 16;21(1):709
pubmed: 34130642
Crit Care Med. 2020 Jun;48(6):822-829
pubmed: 32317596
Crit Care Med. 2017 Sep;45(9):1436-1442
pubmed: 28542029
J Natl Compr Canc Netw. 2022 Jan;20(1):45-53
pubmed: 34991066
Ann Intensive Care. 2017 Dec;7(1):26
pubmed: 28265980
Ann Intensive Care. 2018 Mar 27;8(1):40
pubmed: 29582210
JAMA. 2016 Feb 23;315(8):775-87
pubmed: 26903336
Crit Care Med. 2016 Aug;44(8):1553-602
pubmed: 27428118
Chest. 2018 Aug;154(2):309-316
pubmed: 29778659
Crit Care Med. 2017 Dec;45(12):2031-2039
pubmed: 28937407
Lancet Oncol. 2008 Oct;9(10):982-92
pubmed: 19071255