Department of Critical Care Medicine, Instituto Nacional de Cancerología, México. Av. San Fernando No. 22, Col. Sección XVI, Delegación Tlalpan, 14080, México City, Mexico.
QJM. 2011 Jun;104(6):505-11. doi: 10.1093/qjmed/hcq260. Epub 2011 Jan 21.
To evaluate the clinical characteristics and outcomes of critically ill cancer patients with septic shock.
Prospective, observational cohort study.
Medical-surgical intensive care unit (ICU) at the Instituto Nacional de Cancerología located in Mexico City from January 2008 to February 2010. There were no interventions. Eighty-two consecutive cancer patients with septic shock aged over 18 years were prospectively included and evaluated.
During the study period, 620 critically ill cancer patients were admitted to ICU. Ninety-four patients were evaluated for septic shock at the request of ward onco-hematologists or surgeon oncologist responsible for the patient. After being evaluated by the intensivists, 82 patients were admitted to the ICU. Of the 82 patients, 56 (68.3%) had solid tumours and 26 (31.7%) had hematological malignancy. The most frequent sites of infection were: abdominal (57.3%) and respiratory (35.8%). Cultures were positive in 41 (50%) patients. The 63.4% of the patients had three or more organ dysfunctions on the day of their admission to the ICU. Cox multivariate analysis identified the Sequential Organ Failure Assessment (SOFA) score [hazard ratio (HR): 1.11; 95% confidence interval (95% CI): 1.02-1.19, P=0.008) and performance status (PS)≥2 (HR: 1.84; 95% CI: 1.03-3.29, P=0.040) as independent predictors of death to 3 months. The ICU mortality rate was 41.5% (95% CI: 31-52%).
The variables associated with increased mortality were the degree of organ dysfunction determined by SOFA score at ICU admission and PS≥2.
评估危重症癌症合并感染性休克患者的临床特征和结局。
前瞻性观察队列研究。
研究对象为 2008 年 1 月至 2010 年 2 月期间墨西哥城国立癌症研究所内科-外科重症监护病房（ICU）收治的连续 82 例年龄大于 18 岁的癌症合并感染性休克患者。未进行任何干预。
研究期间，共有 620 例危重症癌症患者入住 ICU。有 94 例患者因血液病或外科肿瘤医生的要求被评估为感染性休克。在接受 ICU 医生评估后，有 82 例患者入住 ICU。在这 82 例患者中，56 例（68.3%）为实体瘤患者，26 例（31.7%）为血液恶性肿瘤患者。最常见的感染部位为：腹部（57.3%）和呼吸道（35.8%）。41 例（50%）患者的培养结果为阳性。这些患者在入住 ICU 的当天，有 63.4%的人有 3 个或更多器官功能障碍。Cox 多变量分析确定，序贯器官衰竭评估（SOFA）评分[风险比（HR）：1.11；95%置信区间（95%CI）：1.02-1.19，P=0.008]和 PS≥2（HR：1.84；95%CI：1.03-3.29，P=0.040）是 3 个月死亡率的独立预测因素。ICU 死亡率为 41.5%（95%CI：31-52%）。
与死亡率增加相关的变量是 ICU 入院时 SOFA 评分确定的器官功能障碍程度和 PS≥2。
