Is the Prognosis of Septic Shock Different in Case of Malignancies?

Abstract

In recent years, considerable progress has been made in the management of septic shock (SS). At the same time, patient profiles have changed: patients are older and the proportion of patients with malignant disease has increased. The definition of SS has recently been revised but few data exist on their recent epidemiology and outcome in intensive care units (ICU). We conducted an observational, prospective cohort study in an ICU at Bordeaux University Hospital between January 2011 and December 2016 in order to compare characteristics of adults admitted to the ICU for a SS with and without malignancy. All cases of SS were included. Demographic, diagnostic, therapeutic and prognostic data were analyzed and compared using a chi2, Fisher or Student tests depending on the data analyzed. Among the 5,032 patients admitted to the ICU, 681 had a septic shock, including 311 (46%) with malignancy: 168 solid cancers and 143 hematological malignancies. The mean age was 66 years. In onco-hematological (OH) patients, the origin of SS was mainly respiratory (27%), abdominal (26%) and catheter-related (14%) whereas in the non-OH population the three main sites of infection were lung (38%), intra-abdominal (25%) and urinary tract (16%). While the rate of documentation was not different between the 2 populations (64%), the proportion of bacteremia was higher among OH patients (49% vs 34%). In OH and non-OH patients, the isolated strains were predominantly Gram-negative (67%) but the proportion of non-fermentative bacteria was higher among OH patients (17% vs 11%). The median stay in the ICU was 4 days, the same in OH and non-OH patients. The in-hospital mortality was 33% among OH and non-OH patients. The epidemiology of SS has changed considerably during the last few years as illustrated by our study: older patients and more malignancies. Despite some differences regarding the type of infection, this study showed no differences in terms of mortality between patients with or without malignancy. All authors: No reported disclosures.