Abou Dagher Gilbert, El Khuri Christopher, Chehadeh Ahel Al-Hajj, Chami Ali, Bachir Rana, Zebian Dina, Bou Chebl Ralphe
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
BMJ Open. 2017 Mar 13;7(3):e013502. doi: 10.1136/bmjopen-2016-013502.
Most sepsis studies have looked at the general population. The aim of this study is to report on the characteristics, treatment and hospital mortality of patients with cancer diagnosed with sepsis or septic shock.
A single-centre retrospective study at a tertiary care centre looking at patients with cancer who presented to our tertiary hospital with sepsis, septic shock or bacteraemia between 2010 and 2015.
176 patients with cancer were compared with 176 cancer-free controls.
The primary outcome of this study was the in hospital mortality in both cohorts. Secondary outcomes included patient demographics, emergency department (ED) vital signs and parameters of resuscitation along with laboratory work.
A total of 352 patients were analysed. The mean age at presentation for the cancer group was 65.39±15.04 years, whereas the mean age for the control group was 74.68±14.04 years (p<0.001). In the cancer cohort the respiratory system was the most common site of infection (37.5%) followed by the urinary system (26.7%), while in the cancer-free arm, the urinary system was the most common site of infection (40.9%). intravenous fluid replacement for the first 24 hours was higher in the cancer cohort. ED, intensive care unit and general practice unit length of stay were comparable in both the groups. 95 (54%) patients with cancer died compared with 75 (42.6%) in the cancer-free group. The 28-day hospital mortality in the cancer cohort was 87 (49.4%) vs 46 (26.1%) in the cancer-free cohort (p=0.009). Patients with cancer had a 2.320 (CI 95% 1.225 to 4.395, p=0.010) odds of dying compared with patients without cancer in the setting of sepsis.
This is the first study looking at an in-depth analysis of sepsis in the specific oncology population. Despite aggressive care, patients with cancer have higher hospital mortality than their cancer-free counterparts while adjusting for all other variables.
大多数脓毒症研究关注的是普通人群。本研究的目的是报告诊断为脓毒症或脓毒性休克的癌症患者的特征、治疗及医院死亡率。
在一家三级医疗中心进行的单中心回顾性研究，研究对象为2010年至2015年间因脓毒症、脓毒性休克或菌血症就诊于我院三级医院的癌症患者。
176例癌症患者与176例无癌症对照者进行比较。
本研究的主要结局是两组的住院死亡率。次要结局包括患者人口统计学资料、急诊科生命体征和复苏参数以及实验室检查结果。
共分析了352例患者。癌症组患者就诊时的平均年龄为65.39±15.04岁，而对照组的平均年龄为74.68±14.04岁（p<0.001）。在癌症队列中，呼吸系统是最常见的感染部位（37.5%），其次是泌尿系统（26.7%），而在无癌症组中，泌尿系统是最常见的感染部位（40.9%）。癌症队列中前24小时的静脉补液量更高。两组在急诊科、重症监护病房和普通病房的住院时间相当。95例（54%）癌症患者死亡，无癌症组为75例（42.6%）。癌症队列的28天医院死亡率为87例（49.4%），无癌症队列的为46例（26.1%）（p=0.009）。在脓毒症情况下，癌症患者死亡的几率是无癌症患者的2.320倍（95%CI 为1.225至4.395，p=0.010）。
这是第一项对特定肿瘤患者群体的脓毒症进行深入分析的研究。尽管给予积极治疗，但在调整所有其他变量后，癌症患者的医院死亡率仍高于无癌症患者。
