With advances in cancer treatments, more patients with cancer, including those with hematologic malignancies, are surviving longer. But they are at a significantly higher risk of developing sepsis. Previous research involving a cohort of patients with solid tumors and hematologic malignancies from 1994 to 2015 found the 30-day mortality rate for those with sepsis or septic shock was 42.6%, demonstrating that septic shock is a significant problem associated with high mortality rates.

Therefore, the goal of this retrospective longitudinal study of patients with septic shock admitted to a 52-bed medical intensive care unit (ICU) in a single medical center during a 3-year period from April 2016 to March 2019 was to identify predictors of 28-day mortality in patients with hematologic cancers. These findings were published in the Journal of the National Comprehensive Cancer Network.

Of 809 patients admitted to the ICU who met the clinical criteria for septic shock as defined by the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), 459 also had hematologic malignancies (284 had leukemia, 97 had lymphoma, and 78 had other hematologic malignancies); 109 of whom had undergone hematopoietic stem cell transplantation (HSCT).


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At 28 days after admission, 311 patients (67.7%) had died. Higher mortality rate associated with higher sequential organ failure assessment (SOFA) score on admission, respiratory failure, and higher lactate levels. Lower 28-day mortality rate was associated with administration of aminoglycosides, higher serum albumin level, and granulocyte colony-stimulating factor (G-CSF).

“These results are an urgent call to action with higher awareness, including the further evaluation of interventions such as earlier ICU admission, aminoglycosides administration, and G-CSF treatment,” the researchers concluded.

They noted that their findings are consistent with existing literature, but the retrospective nature of their single-center study may have limited the generalizability of these findings. This particular center also has a high volume of patients with advanced cancer, which may have a higher percentage of multiorgan dysfunction or failure. 

Disclosures: One author declared an affiliation with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of athors’ disclosures.

Reference

Manjappachar NK, Cuenca JA, Ramirez CM, et al. Outcomes and predictors of 28-day mortality in patients with hematologic malignancies and septic shock defined by Sepsis-3 criteria. J Natl Compr Canc Netw. 2022;20(1):45-53. doi:10.6004/jnccn.2021.7046

This article originally appeared on Oncology Nurse Advisor