Intensive Care and Infectious Disease Unit, CHU Bordeaux, 33000, Bordeaux, France.
Hematology, CHU Bordeaux, 33000, Bordeaux, France.
Support Care Cancer. 2020 Mar;28(3):1325-1333. doi: 10.1007/s00520-019-04937-4. Epub 2019 Jun 26.
In the last decades, the number of cancer patients admitted in intensive care units (ICUs) for septic shock has dramatically increased. However, prognosis data remain scarce.
To assess the 180-day mortality rate in cancer patients admitted to the ICU for septic shock, a 5-year prospective study was performed. All adult patients admitted for septic shock were included and categorized into the following two groups and four subgroups: cancer patients (solid tumor or hematological malignancy) and non-cancer patients (immunocompromised or not). Data were collected and compared between the groups. Upon early ICU admission, the decision to forgo life-sustaining therapy (DFLST) or not was made by consultation among hematologists, oncologists, and the patients or their relatives.
During the study period, 496 patients were admitted for septic shock: 252 cancer patients (119 hematological malignancies and 133 solid tumors) and 244 non-cancer patients. A DFLST was made for 39% of the non-cancer patients and 52% of the cancer patients. The 180-day mortality rate among the cancer patients was 51% and 68% for those with hematological malignancies and solid cancers, respectively. The mortality rate among the non-cancer patients was 44%. In a multivariate analysis, the performance status, Charlson comorbidity index, simplified acute physiology score 2, sequential organ failure assessment score, and DFLST were independent predictors of 180-day mortality.
Despite early admission to the ICU, the 180-day mortality rate due to septic shock was higher in cancer patients compared with non-cancer patients, due to excess mortality in the patients with solid tumors. The long-term prognosis of cancer patients with septic shock is modulated by their general state, severity of organ failure, and DFLST.
在过去几十年中，因感染性休克而入住重症监护病房（ICU）的癌症患者数量显著增加。然而，预后数据仍然有限。
为评估因感染性休克入住 ICU 的癌症患者的 180 天死亡率，进行了一项为期 5 年的前瞻性研究。所有因感染性休克而入院的成年患者均被纳入并分为以下两组和四个亚组：癌症患者（实体瘤或血液恶性肿瘤）和非癌症患者（免疫功能低下或不免疫功能低下）。收集并比较了各组之间的数据。在 ICU 早期入院时，由血液科医生、肿瘤科医生和患者或其亲属共同决定是否放弃生命支持治疗（DFLST）。
在研究期间，共有 496 名患者因感染性休克入院：252 名癌症患者（119 名血液恶性肿瘤和 133 名实体瘤）和 244 名非癌症患者。39%的非癌症患者和 52%的癌症患者进行了 DFLST。癌症患者的 180 天死亡率分别为血液恶性肿瘤和实体瘤患者的 51%和 68%。非癌症患者的死亡率为 44%。在多变量分析中，表现状态、Charlson 合并症指数、简化急性生理学评分 2、序贯器官衰竭评估评分和 DFLST 是 180 天死亡率的独立预测因素。
尽管早期入住 ICU，但因感染性休克导致的 180 天死亡率在癌症患者中高于非癌症患者，这是由于实体瘤患者的死亡率过高所致。感染性休克癌症患者的长期预后受其一般状态、器官衰竭严重程度和 DFLST 调节。
