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Sepsis and septic shock in patients with malignancies : a Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique study

(2020) CRITICAL CARE MEDICINE. 48(6). p.822-829
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Abstract
Objectives: Cancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades. Data Source: Seven European ICUs. Study Selection: A hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors for day 30 mortality. Data Extraction: Data from cancer patients admitted to ICUs for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Reanimation Onco-Hematologique database (1994-2015). Data Synthesis: Overall, 2,062 patients (62% men, median [interquartile range] age 59 yr [48-67 yr]) were included in the study. Underlying malignancies were solid tumors (n = 362; 17.6%) or hematologic malignancies (n = 1,700; 82.4%), including acute leukemia (n = 591; 28.7%), non-Hodgkin lymphoma (n = 461; 22.3%), and myeloma (n = 244; 11.8%). Two-hundred fifty patients (12%) underwent allogeneic hematopoietic stem cell transplantation and 640 (31.0%) were neutropenic at ICU admission. Day 30 mortality was 39.9% (823 deaths). The year of ICU admission was associated with significant decrease in day 30 mortality over time (odds ratio, 0.96; 95% CI, 0.93-0.98; p = 0.001). Mechanical ventilation (odds ratio, 3.25; 95% CI, 2.52-4.19; p < 0.01) and vasopressors use (odds ratio, 1.42; 95% CI, 1.10-1.83; p < 0.01) were independently associated with day 30 mortality, whereas underlying malignancy, allogeneic hematopoietic stem cell transplantation, and neutropenia were not. Conclusions: Survival in critically ill oncology and hematology patients with sepsis improved significantly over time. As outcomes improve, clinicians should consider updating admission policies and goals of care in this population.
Keywords
Critical Care and Intensive Care Medicine, acute kidney injury, hematology, neutropenia, oncology, outcomes, stem cell transplantation, INTENSIVE-CARE-UNIT, CRITICALLY-ILL PATIENTS, INTERNATIONAL CONSENSUS DEFINITIONS, STEM-CELL TRANSPLANTATION, ACUTE MYELOID-LEUKEMIA, CANCER-PATIENTS, NEUTROPENIC PATIENTS, ORGANIZATIONAL CHARACTERISTICS, NONINVASIVE VENTILATION, RESOURCE USE

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MLA
Lemiale, Virginie, et al. “Sepsis and Septic Shock in Patients with Malignancies : A Groupe de Recherche Respiratoire En Réanimation Onco-Hématologique Study.” CRITICAL CARE MEDICINE, vol. 48, no. 6, 2020, pp. 822–29, doi:10.1097/ccm.0000000000004322.
APA
Lemiale, V., Pons, S., Mirouse, A., Tudesq, J.-J., Hourmant, Y., Mokart, D., … Zafrani, L. (2020). Sepsis and septic shock in patients with malignancies : a Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique study. CRITICAL CARE MEDICINE, 48(6), 822–829. https://doi.org/10.1097/ccm.0000000000004322
Chicago author-date
Lemiale, Virginie, Stéphanie Pons, Adrien Mirouse, Jean-Jacques Tudesq, Yannick Hourmant, Djamel Mokart, Frédéric Pène, et al. 2020. “Sepsis and Septic Shock in Patients with Malignancies : A Groupe de Recherche Respiratoire En Réanimation Onco-Hématologique Study.” CRITICAL CARE MEDICINE 48 (6): 822–29. https://doi.org/10.1097/ccm.0000000000004322.
Chicago author-date (all authors)
Lemiale, Virginie, Stéphanie Pons, Adrien Mirouse, Jean-Jacques Tudesq, Yannick Hourmant, Djamel Mokart, Frédéric Pène, Achille Kouatchet, Julien Mayaux, Martine Nyunga, Fabrice Bruneel, Anne-Pascale Meert, Edith Borcoman, Magali Bisbal, Matthieu Legrand, Dominique Benoit, Elie Azoulay, Michaël Darmon, and Lara Zafrani. 2020. “Sepsis and Septic Shock in Patients with Malignancies : A Groupe de Recherche Respiratoire En Réanimation Onco-Hématologique Study.” CRITICAL CARE MEDICINE 48 (6): 822–829. doi:10.1097/ccm.0000000000004322.
Vancouver
1.
Lemiale V, Pons S, Mirouse A, Tudesq J-J, Hourmant Y, Mokart D, et al. Sepsis and septic shock in patients with malignancies : a Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique study. CRITICAL CARE MEDICINE. 2020;48(6):822–9.
IEEE
[1]
V. Lemiale et al., “Sepsis and septic shock in patients with malignancies : a Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique study,” CRITICAL CARE MEDICINE, vol. 48, no. 6, pp. 822–829, 2020.
@article{8661545,
  abstract     = {Objectives:

Cancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades.

Data Source:

Seven European ICUs.

Study Selection:

A hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors for day 30 mortality.

Data Extraction:

Data from cancer patients admitted to ICUs for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Reanimation Onco-Hematologique database (1994-2015).

Data Synthesis:

Overall, 2,062 patients (62% men, median [interquartile range] age 59 yr [48-67 yr]) were included in the study. Underlying malignancies were solid tumors (n = 362; 17.6%) or hematologic malignancies (n = 1,700; 82.4%), including acute leukemia (n = 591; 28.7%), non-Hodgkin lymphoma (n = 461; 22.3%), and myeloma (n = 244; 11.8%). Two-hundred fifty patients (12%) underwent allogeneic hematopoietic stem cell transplantation and 640 (31.0%) were neutropenic at ICU admission. Day 30 mortality was 39.9% (823 deaths). The year of ICU admission was associated with significant decrease in day 30 mortality over time (odds ratio, 0.96; 95% CI, 0.93-0.98; p = 0.001). Mechanical ventilation (odds ratio, 3.25; 95% CI, 2.52-4.19; p < 0.01) and vasopressors use (odds ratio, 1.42; 95% CI, 1.10-1.83; p < 0.01) were independently associated with day 30 mortality, whereas underlying malignancy, allogeneic hematopoietic stem cell transplantation, and neutropenia were not.

Conclusions:

Survival in critically ill oncology and hematology patients with sepsis improved significantly over time. As outcomes improve, clinicians should consider updating admission policies and goals of care in this population.},
  author       = {Lemiale, Virginie and Pons, Stéphanie and Mirouse, Adrien and Tudesq, Jean-Jacques and Hourmant, Yannick and Mokart, Djamel and Pène, Frédéric and Kouatchet, Achille and Mayaux, Julien and Nyunga, Martine and Bruneel, Fabrice and Meert, Anne-Pascale and Borcoman, Edith and Bisbal, Magali and Legrand, Matthieu and Benoit, Dominique and Azoulay, Elie and Darmon, Michaël and Zafrani, Lara},
  issn         = {0090-3493},
  journal      = {CRITICAL CARE MEDICINE},
  keywords     = {Critical Care and Intensive Care Medicine,acute kidney injury,hematology,neutropenia,oncology,outcomes,stem cell transplantation,INTENSIVE-CARE-UNIT,CRITICALLY-ILL PATIENTS,INTERNATIONAL CONSENSUS DEFINITIONS,STEM-CELL TRANSPLANTATION,ACUTE MYELOID-LEUKEMIA,CANCER-PATIENTS,NEUTROPENIC PATIENTS,ORGANIZATIONAL CHARACTERISTICS,NONINVASIVE VENTILATION,RESOURCE USE},
  language     = {eng},
  number       = {6},
  pages        = {822--829},
  title        = {Sepsis and septic shock in patients with malignancies : a Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique study},
  url          = {http://dx.doi.org/10.1097/ccm.0000000000004322},
  volume       = {48},
  year         = {2020},
}

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