Kim Sang-Min, Kim Youn-Jung, Kim Ye-Jee, Kim Won-Young
Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul 05505, Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul 05505, Korea.
Cancers (Basel). 2022 Jul 24;14(15):3601. doi: 10.3390/cancers14153601.
(1) Background: Neutropenia's prognostic impact on mortality in cancer patients with septic shock remains controversial despite recent advances in cancer and sepsis management. This population-based, case-control study aimed to determine whether neutropenia could be related to an increase in short-term and long-term mortality. (2) Methods: This population-based, case-control study used data from the National Health Insurance Service of Korea. Adult cancer patients who presented to the emergency department with septic shock from 2009 to 2017 were included. The 30-day and 1-year mortality rates were evaluated as short-term and long-term outcomes. Cox proportional hazard regression was performed after adjusting for age, sex, Charlson comorbidity index, and neutropenia. (3) Results: In 43,466 adult cancer patients with septic shock, the 30-day and 1-year mortality rates were 52.1% and 81.3%, respectively. In total, 6391 patients had neutropenic septic shock, and the prevalent cancer type was lung cancer, followed by leukemia, non-Hodgkin's lymphoma, stomach cancer, and colon cancer. Furthermore, 30-day and 1-year mortality was lower in patients with neutropenia than in those without neutropenia. After adjustment for confounders, neutropenia was independently associated with decreased 30-day and 1-year mortality rates. (4) Conclusions: In cancer patients presenting to the emergency department with septic shock, the presence of neutropenia did not increase mortality. This suggests that neutropenia may not be used as a single triage criterion for withholding intensive care in cancer patients presenting to the emergency department with septic shock.
(1) 背景：尽管癌症和脓毒症管理方面最近取得了进展，但中性粒细胞减少症对癌症合并感染性休克患者死亡率的预后影响仍存在争议。这项基于人群的病例对照研究旨在确定中性粒细胞减少症是否与短期和长期死亡率增加有关。(2) 方法：这项基于人群的病例对照研究使用了韩国国民健康保险服务的数据。纳入了2009年至2017年因感染性休克就诊于急诊科的成年癌症患者。将30天和1年死亡率评估为短期和长期结局。在调整年龄、性别、查尔森合并症指数和中性粒细胞减少症后进行Cox比例风险回归分析。(3) 结果：在43466例成年癌症合并感染性休克患者中，30天和1年死亡率分别为52.1%和81.3%。共有6391例患者发生中性粒细胞减少性感染性休克，最常见的癌症类型是肺癌，其次是白血病、非霍奇金淋巴瘤、胃癌和结肠癌。此外，中性粒细胞减少症患者的30天和1年死亡率低于无中性粒细胞减少症的患者。在调整混杂因素后，中性粒细胞减少症与30天和1年死亡率降低独立相关。(4) 结论：在因感染性休克就诊于急诊科的癌症患者中，中性粒细胞减少症的存在并未增加死亡率。这表明中性粒细胞减少症可能不能作为对因感染性休克就诊于急诊科的癌症患者拒绝重症监护的单一分诊标准。
