Effect of organ failure on outcomes in neutropenic sepsis

Introduction

The objective was to assess correlation between organ failure and outcomes in patients admitted with neutropenic sepsis to an adult ICU in a district general hospital.

Methods

Retrospective data were collected for admissions with neutropenic sepsis to the ICU over a 3-year period. The Ward Watcher electronic system was used to collect data on the level of organ support on the ICU. Outcomes assessed were 30-day and 1-year mortality.

Results

Twenty-nine neutropenic patients were admitted during the study period; 93% had haematological malignancy while 7% showed no evidence of malignancy. The mean neutrophil count was 0.2 × 10⁹/l and 52% had zero count during their ICU stay. A total of 41.3% had positive blood cultures. Mortality with negative blood cultures was 73%. Overall 30-day mortality was 58.6% and 1-year mortality was 79.3%. Ventilator support was needed in 83% with a mortality of 88%. Inotropes were required in 48.2% and there was a 71% 30-day mortality. Renal support was commenced in 27.5% with 100% mortality. The 30-day mortality was 100% in patients requiring invasive ventilation and renal support. Mortality was also 100% in those requiring three-organ support (Figure 1).

Figure 1

Outcomes depending on support level.

Conclusions

Our data suggest a significant mortality in mechanically ventilated patients with neutropenic sepsis. This rises to 100% if two or more organs are supported, especially if one of them is the kidney. Early recognition and intervention to prevent progression to multiorgan failure is paramount to improve outcomes.