Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
Chest. 2022 Nov;162(5):1063-1073. doi: 10.1016/j.chest.2022.05.017. Epub 2022 May 26.
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.
使用第三届国际脓毒症和脓毒性休克定义共识来评估表现为脓毒性休克的实体瘤患者的结局的数据很少。
危重症实体瘤合并脓毒性休克患者 28 天死亡率的独立预测因素有哪些？
纳入 ICU 收治的合并脓毒性休克的实体瘤患者队列。从电子病历中收集人口统计学和临床特征。我们建立了一个简化的多变量逻辑回归模型来识别 28 天死亡率的独立预测因素，并使用 Kaplan-Meier 图来评估生存情况。
共纳入 271 例患者。中位年龄为 62 岁（范围 19-94 岁）；57.2%为男性，53.5%为白人。最常见的基础恶性肿瘤是肺癌（19.2%）、乳腺癌（7.7%）、胰腺癌（7.7%）和结直肠癌（7.4%）。大多数患者（84.5%）患有转移性疾病。ICU 入院后 28 天，188 例患者（69.4%）死亡。幸存者的晚期癌症发生率更高，ICU 入院前的住院时间更长，入院时和整个 ICU 住院期间的序贯器官衰竭评估评分更高（所有 P 值均<.001）。多变量分析确定转移性疾病（OR，3.17；95%CI，1.43-7.03）、呼吸衰竭（OR，2.34；95%CI，1.15-4.74）、乳酸水平升高（OR，3.19；95%CI，1.90-5.36）和 Eastern Cooperative Oncology Group 体能状态评分为 3 或 4 分（OR，2.72；95%CI，1.33-5.57）是 28 天死亡率的独立预测因素。仅有 38 例患者（14%）在没有医疗援助的情况下出院回家。
实体瘤合并脓毒性休克患者的 28 天死亡率相当高。与生存状况较差相关的因素包括晚期肿瘤疾病、较差的功能状态、高乳酸水平和同时发生的急性呼吸衰竭。对于合并脓毒性休克和晚期转移性疾病且功能脆弱的患者，应考虑早期的目标治疗讨论，而不应拒绝为其提供适当水平的治疗。
