Le Borgne Pierrick, Feuillassier Léa, Schenck Maleka, Herbrecht Jean-Etienne, Janssen-Langenstein Ralf, Simand Celestine, Gantzer Justine, Nannini Simon, Fornecker Luc-Matthieu, Alamé Karine, Lefebvre François, Castelain Vincent, Schneider Francis, Clere-Jehl Raphaël
Emergency Department, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France.
Cancers (Basel). 2022 Jun 29;14(13):3196. doi: 10.3390/cancers14133196.
Introduction: Cancer patients are at high risk of developing septic shock (SSh) and are increasingly admitted to ICU given their improved long-term prognosis. We, therefore, compared the prognosis of cancer and non-cancer patients with SSh. Methods: We conducted a monocentric, retrospective cohort study (2013−2019) on patients admitted to ICU for SSh. We compared the clinical characteristics and management and studied short- and long-term mortality with ICU and in-hospital mortality and 1-year survival according to cancer status. Results: We analyzed 239 ICU stays in 210 patients, 59.5% of whom were men (n = 125), with a median age of 66.5 (IQR 56.3−77.0). Of the 121 cancer patients (57.6% of all patients), 70 had solid tumors (33.3%), and 51 had hematological malignancies (24.3%). When comparing ICU stays of patients with versus without cancer (n = 148 vs. n = 91 stays, respectively), mortality reached 30.4% (n = 45) vs. 30.0% (n = 27) in the ICU (p = 0.95), and 41.6% (n = 59) vs. 35.6% (n = 32) in hospital (p = 0.36), respectively. ICU length of stay (LOS) was 5.0 (2.0−11.3) vs. 6.0 (3.0−15.0) days (p = 0.27), whereas in-hospital LOS was 25.5 (13.8−42.0) vs. 19.5 (10.8−41.0) days (p = 0.33). Upon multivariate analysis, renal replacement therapy (OR = 2.29, CI95%: 1.06−4.93, p = 0.03), disseminated intravascular coagulation (OR = 5.89, CI95%: 2.49−13.92, p < 0.01), and mechanical ventilation (OR = 7.85, CI95%: 2.90−21.20, p < 0.01) were associated with ICU mortality, whereas malignancy, hematological, or solid tumors were not (OR = 1.41, CI95%: 0.65−3.04; p = 0.38). Similarly, overall cancer status was not associated with in-hospital mortality (OR = 1.99, CI95%: 0.98−4.03, p = 0.06); however, solid cancers were associated with increased in-hospital mortality (OR = 2.52, CI95%: 1.12−5.67, p = 0.03). Lastly, mortality was not significantly different at 365-day follow-up between patients with and without cancer. Conclusions: In-hospital and ICU mortality, as well as LOS, were not different in SSh patients with and without cancer, suggesting that malignancies should no longer be considered a barrier to ICU admission.
癌症患者发生感染性休克（SSh）的风险很高，并且鉴于其长期预后有所改善，越来越多地被收入重症监护病房（ICU）。因此，我们比较了患有SSh的癌症患者和非癌症患者的预后。方法：我们对因SSh入住ICU的患者进行了一项单中心回顾性队列研究（2013 - 2019年）。我们比较了临床特征和治疗情况，并根据癌症状态研究了短期和长期死亡率、ICU死亡率、住院死亡率以及1年生存率。结果：我们分析了210例患者的239次ICU住院情况，其中59.5%为男性（n = 125），中位年龄为66.5岁（四分位间距56.3 - 77.0）。在121例癌症患者中（占所有患者的57.6%），70例患有实体瘤（33.3%），51例患有血液系统恶性肿瘤（24.3%）。比较有癌症和无癌症患者的ICU住院情况（分别为n = 148次和n = 91次住院），ICU死亡率分别为30.4%（n = 45）和30.0%（n = 27）（p = 0.95），住院死亡率分别为41.6%（n = 59）和35.6%（n = 32）（p = 0.36）。ICU住院时间（LOS）为5.0（2.0 - 11.3）天和6.0（3.0 - 15.0）天（p = 0.27），而住院LOS为25.5（13.8 - 42.0）天和19.5（10.8 - 41.0）天（p = 0.33）。多因素分析显示，肾脏替代治疗（OR = 2.29，95%置信区间：1.06 - 4.93，p = 0.03）、弥散性血管内凝血（OR = 5.89，95%置信区间：2.49 - 13.92，p < 0.01）和机械通气（OR = 7.85，95%置信区间：2.90 - 21.20，p < 0.01）与ICU死亡率相关，而恶性肿瘤、血液系统或实体瘤则无相关性（OR = 1.41，95%置信区间：0.65 - 3.04；p = 0.38）。同样，总体癌症状态与住院死亡率无关（OR = 1.99，95%置信区间：0.98 - 4.03，p = 0.06）；然而，实体癌与住院死亡率增加相关（OR = 2.52，95%置信区间：1.12 - 5.67，p = 0.03）。最后，有癌症和无癌症患者在365天随访时的死亡率无显著差异。结论：有癌症和无癌症的SSh患者的住院死亡率、ICU死亡率以及住院时间无差异，这表明恶性肿瘤不应再被视为入住ICU的障碍。
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