Outcome and prognostic factors in critically ill cancer patients with diagnosis of sepsis in the ICU

Introduction

As overall survival times increase for patients with cancer due to novel antitumour treatments, there will be an inevitable escalation in the number of such patients who present to intensive care with intercurrent acute illness, and sepsis is the most frequent diagnosis in this context. Epidemiologic estimates of sepsis among cancer patients are limited. The aim of this study was to assess survival in cancer patients admitted to an ICU with a diagnosis of sepsis, trying to identify predictive factors of mortality.

Methods

A prospective cohort study in an ICU at a university cancer referral center. From a total of 95 patients admitted to the ICU during a period of 3 months, 78 patients had the diagnosis of sepsis into 24 hours of admission. Patient charts were analyzed with respect to underlying disease, cause of admission, APACHE II score, need and duration for mechanical ventilation, neutropenia and development of septic shock, type of infection, time to antibiotic therapy, as well as ICU survival and survival after discharge.

Results

ICU survival of septic patients was 76%, and 1-month survival was 66%. In a multivariate analysis, prognosis was negatively influenced by respiratory insufficiency, the need for mechanical ventilation, and development of septic shock and renal failure after 72 hours of ICU stay. Admission after cardiopulmonary resuscitation yielded high ICU mortality. Age, neutropenia, type of infection, and underlying disease did not influence outcome significantly. Admission APACHE II scores were significantly higher in nonsurvivors but failed to predict individual outcome satisfactorily.

Conclusion

A combination of factors must be taken into account to estimate a critically ill cancer patient's prognosis in the ICU admitted because of sepsis. The APACHE II scoring system alone should not be used to make decisions about therapy prolongation. As ICU mortality is 24%, comparable with severely ill noncancer patients, general reluctance to admit cancer patients to an ICU does not seem to be justified.