Patients with severe sepsis and solid tumours: outcome and prognostic factors

Introduction

Admission to the ICU and the appropriate selection of patients improved the treatment and survival rates of critical oncological patients [1]. Infection is an important complication in these patients, which frequently leads to acute organ dysfunction and even death [2, 3]. The objective is to evaluate the outcome and prognostic factors in a group of patients with severe sepsis and solid tumours.

Methods

A retrospective observational study of collected data in 140 consecutive admissions to the ICU over a 24-month period at our oncological hospital; 108 patients were evaluated, corresponding to 140 admissions to the ICU (19.5% of total admissions).

Results

Age, sex, the underlying disease and tumour stage (TNM classification), type of previous anticancer treatment, performance status, severity scores (APACHE II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment), ICU and hospital mortalities and hospital outcome at 3, 6 and 12 months were analysed. The majority were male with median age 64.5 years; 26% had head and neck tumours, 21% oesophagus and gastric cancers, 16% colon and rectum cancer, 9% breast cancer, 1% genitourinary tumours and 14% other solid tumours; 91.4% of patients required mechanical ventilation, 42% vasopressors, and 4% kidney replacement therapy. Decisions to forgo (withhold or withdraw) life-sustaining therapies were taken in 19% of patients. In the patients with the intention to treat, the ICU and hospital survival rates were 76.5% and 56.3%. Survival rates at 3, 6 and 12 months were 97%, 81% and 45%, respectively.

Conclusion

Severity scores (APACHE II, Simplified Acute Physiology Score II, Sequential Organ Failure Assessment) in the first 24 hours did not discriminate clearly between survivors and nonsurvivors [1]. Mortality for cancer patients with severe sepsis turned out to be unrelated to age [4]. Clinical judgment between oncologists and intensive care physicians is necessary to improve the selection of patients who might benefit from intensive care [5]. Long-term survival is predicted by cancer disease-prognostic factors.