Comparison of Short- and Long-Term Mortality in Patients with or without Cancer Admitted to the ICU for Septic Shock: A Retrospective Observational Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Study Population and Settings
2.2. Data Collection
2.3. Ethics
2.4. Statistical Analysis
3. Results
3.1. Baseline Characteristics of the Study Population
3.2. Comparisons between Non-Cancer Patients versus Cancer Patients with SSh
3.3. Multivariate Analysis of Factors Associated with Mortality
3.4. Long-Term Survival Outcome
3.5. Medical Economics Analysis
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All Patients N = 210 | Non-Cancer Patients n = 89 | Cancer Patients n = 121 | p Value | |
---|---|---|---|---|
Age (years) | 66.5 [56.3–77.0] | 69.0 [57.0–82.0] | 64.0 [56.0–75.0] | 0.02 * |
Male | 125 (59.5) | 52 (63.4) | 73 (57.0) | 0.36 |
Comorbidities | ||||
Hypertension | 111 (53.1) | 54 (60.7) | 57 (47.5) | 0.06 |
Body mass index | 25.1 [21.9–29.1] | 26.1 [23.3–30.1] | 24.2 [21.3–27.7] | <0.01 * |
Cardiovascular diseases | 88 (41.9) | 44 (49.4) | 44 (36.4) | 0.06 |
Diabetes mellitus | 62 (29.7) | 34 (38.2) | 28 (23.3) | 0.02 * |
Pre-existing renal failure | 28 (13.3) | 16 (18.0) | 12 (9.9) | 0.09 |
Respiratory diseases | 68 (32.4) | 35 (39.3) | 33 (27.3) | 0.07 |
Knaus score | 6.0 [5.0–6.0] | 6.0 [5.0–6.0] | 6.0 [6.0–6.0] | <0.01 * |
Charlson Comorbidity Index | 6.0 [3.0–9.0] | 5.0 [2.0–7.0] | 7.0 [4.0–10.0] | <0.01 * |
Cognitive impairment | 24 (11.4) | 20 (22.5) | 4 (3.3) | <0.01 * |
History of prior ICU stay | 125 (59.5) | 42 (47.2) | 83 (68.6) | <0.01 * |
Long-term mortality # | ||||
At d90 | 84 (40.4) | 33(37.5) | 51 (42.5) | 0.47 |
At d180 | 98 (47.3) | 37 (42.0) | 61(51.3) | 0.19 |
At d365 (1 year) | 109 (53.7) | 40 (47.6) | 69 (58.0) | 0.14 |
All Stays N = 239 | Stays of Non-Cancer Patients n = 91 | Stays of Cancer Patients n = 148 | p Value | |
---|---|---|---|---|
Treatments before ICU admission | ||||
Fluid therapy | 178 (76.1) | 67 (74.4) | 111 (77.1) | 0.65 |
Norepinephrine | 80 (33.9) | 32 (35.2) | 48 (33.1) | 0.74 |
Site of infection | ||||
Respiratory tract | 104 (43.5) | 42 (46.2) | 62 (41.9) | 0.52 |
Urinary tract | 58 (24.3) | 25 (27.5) | 33 (22.3) | 0.36 |
Gastrointestinal tract | 75 (31.4) | 28 (30.8) | 47 (31.8) | 0.87 |
Skin and soft tissue | 27 (11.3) | 18 (19.8) | 9 (6.1) | <0.01 * |
CRBSI | 19 (8.0) | 3 (3.3) | 16 (10.8) | 0.04 * |
Central nervous system | 1 (0.4) | 1 (1.1) | 0 (0.0) | 0.76 |
Osteoarticular system | 7 (2.9) | 6 (6.6) | 1 (0.7) | 0.03 * |
Other sites | 10 (4.2) | 7 (7.7) | 3 (2.0) | 0.08 |
Unknown site | 23 (9.6) | 3 (3.3) | 20 (13.5) | <0.01 * |
Laboratory findings # | ||||
Creatinine (μmol/L) | 130.0 [87.1–192.7] | 134.0 [92.0–236.0] | 118.0 [83.4–172.3] | 0.03 * |
CRP (mg/L) | 166.5 [92.7–249.5] | 172.5 [99.1–249.1] | 163.0 [84.0–249.3] | 0.42 |
Lactate (mmol/L) | 2.6 [1.7–4.1] | 2.7 [1.8–4.1] | 2.4 [1.6–4.2] | 0.98 |
Hemoglobin (g/dL) | 9.6 [8.2–11.0] | 10.5 [8.9–12.3] | 9.1 [7.8–10.2] | <0.01 * |
WBC count (109/L) | 14.1 [9.1–22.3] | 16.4 [11.5–23.1] | 12.3 [5.3–21.6] | <0.01 * |
Neutrophil count (109/L) | 11.7 [6.6–19.0] | 14.0 [10.1–20.2] | 9.5 [3.8–18.4] | <0.01 * |
Platelet count (109/L) | 133.0 [63.0–235.0] | 177.0 [110.5–270.5] | 105.0 [34.0–211.5] | <0.01 * |
ICU stay | ||||
SAPS II | 51.0 [42.0–68.0] | 50.0 [43.5–65.5] | 55.5 [41.8–68.0] | 0.44 |
Duration of ATB therapy (days) | 5.0 [3.0–10.5] | 6.0 [3.0–11.0] | 5.0 [2.0–10.3] | 0.25 |
Antifungal therapy | 121 (50.6) | 33 (36.3) | 88 (59.5) | <0.01 * |
Catecholamines | 226 (94.6) | 87 (95.6) | 139 (93.9) | 0.81 |
Renal replacement therapy | 70 (29.3) | 33 (36.3) | 37 (25.0) | 0.06 |
NIV | 55 (23.0) | 26 (28.6) | 29 (19.6) | 0.11 |
Mechanical ventilation | 143 (59.8) | 60 (65.9) | 83 (56.1) | 0.13 |
Duration of MV (days) | 5.0 [2.0–11.0] | 6.0 [2.8–15.5] | 5.0 [2.0–10.5] | 0.38 |
DIC | 44 (18.6) | 18 (20.0) | 26 (17.8) | 0.67 |
MODS | 79 (33.1) | 36 (39.6) | 43 (29.1) | 0.09 |
ARDS | 26 (10.9) | 9 (9.9) | 17 (11.5) | 0.70 |
Transfusions | 152 (63.6) | 45 (49.5) | 107 (72.3) | <0.01 * |
Red blood cells | 143 (59.8) | 43 (47.3) | 100 (67.6) | <0.01 * |
Fresh frozen plasma | 51 (21.3) | 18 (19.8) | 33 (22.3) | 0.64 |
Platelet concentrates | 87 (36.4) | 18 (19.8) | 69 (46.6) | <0.01 * |
Advance directives | 13 (5.4) | 6 (6.6) | 7 (4.7) | 0.73 |
LTE in the ICU | 47 (19.7) | 18 (19.8) | 29 (19.6) | 0.97 |
Outcome | ||||
ICU LOS (days) | 5.0 [3.0–13.0] | 6.0 [3.0–15.0] | 5.0 [2.0–11.3] | 0.27 |
Total LOS (days) | 24.0 [12.0–42.0] | 19.5 [10.8–41.0] | 25.5 [13.8–42.0] | 0.33 |
Mortality | ||||
At d28 | 65 (27.3) | 27 (29.7) | 38 (25.9) | 0.52 |
In the ICU | 72 (30.3) | 27 (30.0) | 45 (30.4) | 0.95 |
In hospital | 91 (39.2) | 32 (35.6) | 59 (41.6) | 0.36 |
(a) ICU Mortality | Odds Ratio | 95%CI | p Value |
Age (years) | 1.00 | [0.98–1.02] | 0.91 |
Cancer patients with SSh | 1.41 | [0.65–3.04] | 0.38 |
Solid tumors | 1.48 | [0.62–3.51] | 0.37 |
Hematological malignancies | 1.33 | [0.53–3.32] | 0.54 |
ARDS | 1.03 | [0.39–2.75] | 0.95 |
Renal replacement therapy | 2.29 | [1.06–4.93] | 0.03 * |
DIC | 5.89 | [2.49–13.92] | <0.01 * |
Mechanical ventilation | 7.85 | [2.90–21.20] | <0.01 * |
Nosocomial infection | 1.82 | [0.89–3.69] | 0.10 |
Bacteremia | 1.39 | [0.67–2.88] | 0.37 |
(b) In-hospital mortality | |||
Age (years) | 1.01 | [0.99–1.04] | 0.19 |
Cancer patients with SSh | 1.99 | [0.98–4.03] | 0.06 |
Solid tumors | 2.52 | [1.12–5.67] | 0.03 * |
Hematological malignancies | 1.62 | [0.67–3.87] | 0.28 |
ARDS | 1.24 | [0.47–3.26] | 0.66 |
Renal replacement therapy | 2.50 | [1.20–5.20] | 0.01 * |
DIC | 3.70 | [1.62–8.46] | <0.01 * |
Mechanical ventilation | 4.56 | [2.15–9.65] | <0.01 * |
Nosocomial infection | 1.73 | [0.91–3.29] | 0.10 |
Bacteremia | 1.30 | [0.68–2.50] | 0.42 |
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Le Borgne, P.; Feuillassier, L.; Schenck, M.; Herbrecht, J.-E.; Janssen-Langenstein, R.; Simand, C.; Gantzer, J.; Nannini, S.; Fornecker, L.-M.; Alamé, K.; et al. Comparison of Short- and Long-Term Mortality in Patients with or without Cancer Admitted to the ICU for Septic Shock: A Retrospective Observational Study. Cancers 2022, 14, 3196. https://doi.org/10.3390/cancers14133196
Le Borgne P, Feuillassier L, Schenck M, Herbrecht J-E, Janssen-Langenstein R, Simand C, Gantzer J, Nannini S, Fornecker L-M, Alamé K, et al. Comparison of Short- and Long-Term Mortality in Patients with or without Cancer Admitted to the ICU for Septic Shock: A Retrospective Observational Study. Cancers. 2022; 14(13):3196. https://doi.org/10.3390/cancers14133196
Chicago/Turabian StyleLe Borgne, Pierrick, Léa Feuillassier, Maleka Schenck, Jean-Etienne Herbrecht, Ralf Janssen-Langenstein, Celestine Simand, Justine Gantzer, Simon Nannini, Luc-Matthieu Fornecker, Karine Alamé, and et al. 2022. "Comparison of Short- and Long-Term Mortality in Patients with or without Cancer Admitted to the ICU for Septic Shock: A Retrospective Observational Study" Cancers 14, no. 13: 3196. https://doi.org/10.3390/cancers14133196