Abstract
IntroductionThe overall prognosis of critically ill patients with cancer has improved during the past decade. The aim of this study was to identify early prognostic factors of intensive care unit (ICU) mortality in patients with cancer.MethodsWe designed a prospective, consecutive, observational study over a one-year period. Fifty-one cancer patients with septic shock were enrolled.ResultsThe ICU mortality rate was 51% (26 deaths). Among the 45 patients who benefited from transthoracic echocardiography evaluation, 17 showed right ventricular dysfunction, 18 showed left ventricular diastolic dysfunction, 18 showed left ventricular systolic dysfunction, and 11 did not show any cardiac dysfunction. During the first three days of ICU course, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly higher in patients presenting cardiac dysfunctions compared to patients without any cardiac dysfunction. Multivariate analysis discriminated early prognostic factors (within the first 24 hours after the septic shock diagnosis). ICU mortality was independently associated with NT-proBNP levels at day 2 (odds ratio, 1.2; 95% confidence interval, 1.004 to 1.32; p = 0.022). An NT-proBNP level of more than 6,624 pg/ml predicted ICU mortality with a sensitivity of 86%, a specificity of 77%, a positive predictive value of 79%, a negative predictive value of 85%, and an accuracy of 81%.ConclusionWe observed that critically ill cancer patients with septic shock have an approximately 50% chance of survival to ICU discharge. NT-proBNP was independently associated with ICU mortality within the first 24 hours. NT-proBNP could be a useful tool for detecting high-risk cancer patients within the first 24 hours after septic shock diagnosis.
Highlights
The overall prognosis of critically ill patients with cancer has improved during the past decade
Among the 45 patients who benefited from transthoracic echocardiography evaluation, showed right ventricular dysfunction, showed left ventricular diastolic dysfunction, 18 showed left ventricular systolic dysfunction, and 11 did not show any cardiac dysfunction
intensive care unit (ICU) mortality was independently associated with NT-pro-brain natriuretic peptide (proBNP) levels at day 2
Summary
The overall prognosis of critically ill patients with cancer has improved during the past decade. Reports concerning critically ill patients with malignancies admitted to the intensive care unit (ICU) include a wide range of causes, including septic shock. In this population, mortality rates tend to be approximately 50% when septic shock is present [2,3]. Cardiac troponins and natriuretic peptides are commonly used for diagnosis and risk stratification in patients with acute coronary syndrome and congestive heart failure. Their prognostic and diagnostic relevance is still under investigation in patients with septic shock [6]. The precursor molecule proBNP is split into Nterminal proBNP (NT-proBNP) and the physiologically active
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