Outcome of septic shock in patients with malignancies and neutropenia

Background

Septic complication remains an important influence on survival rate in patients with malignancies. Bone marrow suppression and neutropenia induced by chemotherapy determine certain difficulties in early diagnose of sepsis, and lead to rapid hemodynamics and respiratory disorders. The aim of this study was to standardize most important issues in treatment of sepsis-induced arterial hypotension and tissue hypoperfusion and to estimate its influence on survival rate in patients with severe sepsis and septic shock.

Materials and methods

Sixty-two consecutive patients aged from 1 to 17 years old, with malignancies, neutropenia and sepsis associated with hypotension, were followed in the ICU of the Republican Center for Pediatric Oncology and Hematology. Thirty-five patients treated from January 2000 to December 2001 composed the retrospective group; the prospective group consisted of 27 patients, treated from March 2003 to September 2004. Treatment protocol for septic shock therapy used EBM principles and the design for the prospective group strictly determined the following treatment options: hydroxyethyl starch (HES) as a first choice for volume resuscitation; combination of dopamine and norepinephrine for correction of arterial hypotension; double-lumen catheter (or two central lines) for dividing infusions of dopamine and noradrenalin from others; mandatory use of arterial lines for invasive blood pressure monitoring; and start-up of mandatory ventilation in all patients with septic shock, even in patients with compensated blood gas status, We compared the survival rate and survival probability during the first 75 days after ICU admission. For the statistical analysis, the chi-square test and the Caplan–Meyer method were used.

Results

Survival probability measured by log-rank test during 75 days after ICU admission showed a significant difference. Using our protocol, we also found a difference in maximal lactate level on the day of admission, duration of arterial hypotension, length of ICU stay and length of ventilation between two groups.

The overall ICU mortality rate was significantly different in the retrospective and prospective groups – 81.3% and 53%, respectively (P < 0.05).

Conclusion

Using the presented treatment protocol for septic shock positively influenced mortality rate in the prospective group.

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