Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate

Frontiers in Medicine

Álvaro Salazar¹  Camila Moscoso¹  Rodrigo Pérez-Araos²  José Miguel Montes³  René López³  Jerónimo Graf³  Suraj Samtani⁴  Fernanda Baus⁵ 

[1] Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile;Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile;Escuela de Kinesiología, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile;Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile;Escuela de Medicina, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile;Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago, Chile;Escuela de Medicina, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile;Medical Oncology, Fundación Chilena de Inmuno Oncologia, Santiago, Chile;Medical Oncology Service, Clinica Bradford Hill, Santiago, Chile;Escuela de Kinesiología, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile;

关键词: cancer;    intensive care unit;    septic shock;    oncological patient;    cancer prevention and control;   

DOI  :  10.3389/fmed.2021.603275

来源: Frontiers

【 摘 要 】

The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, p = 0.013) and associated with lower survival (65.4% vs. 85.7%, p = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998–24.731], p = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402–5.160], p = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.

【 授权许可】

CC BY