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Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies

Dominique Vandijck UGent, Dominique Benoit UGent, Pieter Depuydt UGent, Fritz Offner UGent, Stijn Blot UGent, Anna K Van Tilborgh, JOKE NOLLET UGent, EVA STEEL, Lucien Noens UGent and Johan Decruyenaere UGent (2008) INTENSIVE CARE MEDICINE. 34(5). p.847-855
abstract
Objective: To compare the characteristics and outcome of patients with hematological malignancies referred to the ICU with severe sepsis and septic shock who had or had not received recent intravenous chemotherapy, defined as within 3 weeks prior to ICU admission. Design and setting: Retrospective observational cohort study on prospectively collected data in a medical ICU of a university hospital. Patients: 186 ICU patients with hematological malignancies with severe sepsis or septic shock (2000-2006). Measurements and results: There were 77 patients admitted with severe sepsis and 109 with septic shock; 91 (49%) had received recent intravenous chemotherapy. Patients with recent chemotherapy more often had a high-grade malignancy and were more often neutropenic, less often had pulmonary infiltrates, and less often required mechanical ventilation. ICU, 28-day, in-hospital, and 6-month mortality rates were 33% vs. 48.4%, 40.7% vs. 57.4%, 45.1% vs. 58.9%, and 50.5% vs. 63.2% in patients with and without recent chemotherapy, respectively. Logistic regression identified four variables independently associated with 28-day mortality: SOFA score at ICU admission, pulmonary site of infection, and fungal infection were associated with worse outcome whereas previous intravenous chemotherapy was protective at borderline significance. After adjustment with a propensity score for recent chemotherapy, chemotherapy was not associated with outcome. Conclusions: Patients referred to the ICU with severe sepsis and septic shock complicating active chemotherapeutic treatment have better prognosis than commonly perceived.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
severe sepsis, septic shock, hematological malignancy, intensive care unit, outcome, intravenous chemotherapy, INTENSIVE-CARE-UNIT, ACUTE RESPIRATORY-FAILURE, MECHANICAL VENTILATORY SUPPORT, ILL CANCER-PATIENTS, NEUTROPENIC PATIENTS, IMMUNOCOMPROMISED PATIENTS, INVASIVE ASPERGILLOSIS, IMPROVED SURVIVAL, ADMISSION, PNEUMONIA
journal title
INTENSIVE CARE MEDICINE
Intensive Care Med.
volume
34
issue
5
pages
847-855 pages
Web of Science type
Article
Web of Science id
000255091900009
JCR category
CRITICAL CARE MEDICINE
JCR impact factor
5.055 (2008)
JCR rank
3/21 (2008)
JCR quartile
1 (2008)
ISSN
0342-4642
DOI
10.1007/s00134-008-1002-2
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
414601
handle
http://hdl.handle.net/1854/LU-414601
date created
2008-05-05 13:04:00
date last changed
2016-12-19 15:43:29
@article{414601,
  abstract     = {Objective: To compare the characteristics and outcome of patients with hematological malignancies referred to the ICU with severe sepsis and septic shock who had or had not received recent intravenous chemotherapy, defined as within 3 weeks prior to ICU admission.
Design and setting: Retrospective observational cohort study on prospectively collected data in a medical ICU of a university hospital.
Patients: 186 ICU patients with hematological malignancies with severe sepsis or septic shock (2000-2006).
Measurements and results: There were 77 patients admitted with severe sepsis and 109 with septic shock; 91 (49\%) had received recent intravenous chemotherapy. Patients with recent chemotherapy more often had a high-grade malignancy and were more often neutropenic, less often had pulmonary infiltrates, and less often required mechanical ventilation. ICU, 28-day, in-hospital, and 6-month mortality rates were 33\% vs. 48.4\%, 40.7\% vs. 57.4\%, 45.1\% vs. 58.9\%, and 50.5\% vs. 63.2\% in patients with and without recent chemotherapy, respectively. Logistic regression identified four variables independently associated with 28-day mortality: SOFA score at ICU admission, pulmonary site of infection, and fungal infection were associated with worse outcome whereas previous intravenous chemotherapy was protective at borderline significance. After adjustment with a propensity score for recent chemotherapy, chemotherapy was not associated with outcome.
Conclusions: Patients referred to the ICU with severe sepsis and septic shock complicating active chemotherapeutic treatment have better prognosis than commonly perceived.},
  author       = {Vandijck, Dominique and Benoit, Dominique and Depuydt, Pieter and Offner, Fritz and Blot, Stijn and Van Tilborgh, Anna K and NOLLET, JOKE and STEEL, EVA and Noens, Lucien and Decruyenaere, Johan},
  issn         = {0342-4642},
  journal      = {INTENSIVE CARE MEDICINE},
  keyword      = {severe sepsis,septic shock,hematological malignancy,intensive care unit,outcome,intravenous chemotherapy,INTENSIVE-CARE-UNIT,ACUTE RESPIRATORY-FAILURE,MECHANICAL VENTILATORY SUPPORT,ILL CANCER-PATIENTS,NEUTROPENIC PATIENTS,IMMUNOCOMPROMISED PATIENTS,INVASIVE ASPERGILLOSIS,IMPROVED SURVIVAL,ADMISSION,PNEUMONIA},
  language     = {eng},
  number       = {5},
  pages        = {847--855},
  title        = {Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies},
  url          = {http://dx.doi.org/10.1007/s00134-008-1002-2},
  volume       = {34},
  year         = {2008},
}

Chicago
Vandijck, Dominique, Dominique Benoit, Pieter Depuydt, Fritz Offner, Stijn Blot, Anna K Van Tilborgh, JOKE NOLLET, EVA STEEL, Lucien Noens, and Johan Decruyenaere. 2008. “Impact of Recent Intravenous Chemotherapy on Outcome in Severe Sepsis and Septic Shock Patients with Hematological Malignancies.” Intensive Care Medicine 34 (5): 847–855.
APA
Vandijck, D., Benoit, D., Depuydt, P., Offner, F., Blot, S., Van Tilborgh, A. K., NOLLET, J., et al. (2008). Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. INTENSIVE CARE MEDICINE, 34(5), 847–855.
Vancouver
1.
Vandijck D, Benoit D, Depuydt P, Offner F, Blot S, Van Tilborgh AK, et al. Impact of recent intravenous chemotherapy on outcome in severe sepsis and septic shock patients with hematological malignancies. INTENSIVE CARE MEDICINE. 2008;34(5):847–55.
MLA
Vandijck, Dominique, Dominique Benoit, Pieter Depuydt, et al. “Impact of Recent Intravenous Chemotherapy on Outcome in Severe Sepsis and Septic Shock Patients with Hematological Malignancies.” INTENSIVE CARE MEDICINE 34.5 (2008): 847–855. Print.