ICU, Instituto Nacional de Câncer, Rio de Janeiro, Brazil 20230-130; Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil 20231-050.
J Crit Care. 2012 Jun;27(3):301-7. doi: 10.1016/j.jcrc.2011.06.014. Epub 2011 Aug 19.
The purposes of this study were to evaluate the clinical course and to identify independent predictors of mortality in patients with cancer with sepsis.
This is a secondary analysis of a prospective cohort study conducted at an oncological medical-surgical intensive care unit. Logistic regression was used to identify predictors of hospital mortality.
A total of 563 patients (77% solid tumor, 23% hematologic malignancies) were included over a 55-month period. The most frequent sites of infection were the lung, abdomen, and urinary tract; 91% patients had severe sepsis/septic shock. Gram-negative bacteria were responsible for more than half of the episodes of infection; 38% of patients had polymicrobial infections. Intensive care unit, hospital, and 6-month mortality rates were 51%, 65%, and 72%, respectively. In multivariate analyses, sepsis in the context of medical complications; active disease; compromised performance status; presence of 3 to 4 systemic inflammatory response syndrome criteria; and the presence of respiratory, renal, and cardiovascular failures were associated with increased mortality. Adjusting for other covariates, patients with non-urinary tract infections, mostly represented by patients with pneumonia and abdominal infections, had worse outcomes.
Sepsis remains a frequent complication in patients with cancer and associated with high mortality. Our results can be of help to assist intensivists in clinical decisions and to improve characterization and risk stratification in these patients.
本研究旨在评估癌症合并脓毒症患者的临床病程，并确定其死亡的独立预测因素。
这是一项在肿瘤内科重症监护病房进行的前瞻性队列研究的二次分析。采用逻辑回归分析确定医院死亡率的预测因素。
在 55 个月的时间内，共纳入了 563 名患者（77%为实体瘤，23%为血液恶性肿瘤）。感染的最常见部位是肺部、腹部和泌尿道；91%的患者患有严重脓毒症/脓毒性休克。革兰氏阴性菌引起的感染超过一半；38%的患者为混合感染。重症监护病房、医院和 6 个月的死亡率分别为 51%、65%和 72%。多变量分析显示，在合并医疗并发症的情况下发生脓毒症；存在活动性疾病；身体状况不佳；出现 3 至 4 项全身炎症反应综合征标准；以及存在呼吸、肾脏和心血管衰竭与死亡率增加相关。在调整其他协变量后，非泌尿道感染患者（主要为肺炎和腹部感染患者）的预后更差。
脓毒症仍然是癌症患者的常见并发症，并与高死亡率相关。我们的研究结果有助于为重症监护医生提供临床决策的帮助，并改善这些患者的特征和风险分层。
