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Outcome in severe sepsis and septic shock patients with hematological malignancies: impact of recent intravenous chemotherapeutic treatment

Introduction

Developing severe sepsis or septic shock after chemotherapeutic treatment is commonly perceived as the worst-case scenario in hematological patients. This study compared the characteristics and outcome of patients with hematological malignancies who were referred to the ICU because of severe sepsis and septic shock who had received versus those who had not received intravenous chemotherapeutic treatment within 3 weeks prior to ICU admission.

Methods

A prospective observational cohort study was conducted at the medical ICU of a tertiary care centre. All consecutive patients with hematological malignancies admitted to this unit between 2000 and 2006, and who were diagnosed with either severe sepsis or septic shock, were considered for analysis.

Results

Seventy-seven patients were admitted with severe sepsis and 109 with septic shock. Ninety-one patients (49%) had received recent intravenous chemotherapy within 3 weeks prior to ICU admission. As compared with those without, patients with recent chemotherapy more often had a high-grade malignancy (P < 0.001), were more often neutropenic (P < 0.001), less often had pulmonary infiltrates (P = 0.007), and less often required mechanical ventilation (P = 0.04). The ICU, 28-day, inhospital, and 6-month mortality rates were 33% versus 48.4% (P = 0.037), 40.7% versus 57.4% (P = 0.027), 45.1% versus 58.9% (P = 0.076), and 50.5% versus 63.2% (P = 0.103), in patients with and without recent chemotherapy, respectively. Logistic regression identified four variables independently associated with 28-day mortality: SOFA score at ICU admission (P < 0.001), pulmonary site of infection (P = 0.005), and fungal infection (P = 0.003) were associated with worse outcome, whereas intravenous chemotherapy within 3 weeks prior to ICU admission was protective at borderline significance (P = 0.049). After more complete adjustment with a propensity score for recent chemotherapy, chemotherapy was no longer associated with outcome (P = 0.079).

Conclusion

Patients referred to the ICU with severe sepsis and septic shock complicating active chemotherapeutic treatment have an overall crude mortality that is comparable with septic shock in general ICU patients, and have a better prognosis than commonly perceived.

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Vandijck, D., Benoit, D., Depuydt, P. et al. Outcome in severe sepsis and septic shock patients with hematological malignancies: impact of recent intravenous chemotherapeutic treatment. Crit Care 12, P488 (2008). https://doi.org/10.1186/cc6709

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Keywords

  • Septic Shock
  • Propensity Score
  • Severe Sepsis
  • Hematological Malignancy
  • Septic Shock Patient