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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 (UGent) , Lucien Noens (UGent) and Johan Decruyenaere (UGent)
(2008) INTENSIVE CARE MEDICINE. 34(5). p.847-855
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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.
Keywords
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

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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.
@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},
}

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