Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate
Journal
Frontiers in Medicine
ISSN
2296-858X
Date Issued
2021
Author(s)
Rodrigo Pérez-Araos
José Miguel Montes
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:p>The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, <jats:italic>p</jats:italic> = 0.013) and associated with lower survival (65.4% vs. 85.7%, <jats:italic>p</jats:italic> = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998–24.731], <jats:italic>p</jats:italic> = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402–5.160], <jats:italic>p</jats:italic> = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.</jats:p>
Subjects
cancer
;
intensive care unit
;
septic shock
;
oncological patient
;
cancer prevention and control
;
hypertensive factor
;
lactic acid
;
noradrenalin
;
acute kidney failure
;
adult
;
adult respiratory distress syndrome
;
aged
;
apache
;
article
;
cancer patient
;
cancer prevention
;
comorbidity
;
controlled study
;
disease association
;
female
;
fluid therapy
;
human
;
hyperlactatemia
;
intensive care unit
;
invasive ventilation
;
major clinical study
;
male
;
mean arterial pressure
;
outcome assessment
;
prospective study
;
retrospective study
;
sepsis
;
septic shock
;
sequential organ failure assessment score
;
solid malignant neoplasm
;
survival rate