Nirmala Manjappachar, MD
Internal Medicine Resident Physician
Anne Arundel Medical Center
Annapolis, MD
Disclosure information not submitted.
John Cuenca, MD (he/him/his)
Clinical Research Assistant
The University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure information not submitted.
Peyton Martin, BS
Research Assistant
The University of Texas MD Anderson Cancer Center, Texas, United States
Disclosure information not submitted.
Cristina Gutierrez, MD
Associate Professor of Critical Care Medicine
University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure information not submitted.
Dereddi Raja Reddy, MD, FACP FCCP
Assistant Professor, Program Director MS4 McGovern Medical School
MD Anderson Cancer Care Center
Houston, Texas
Disclosure information not submitted.
Joshua Botdorf, DO
Assistant Professor
University of Texas MD Anderson Cancer Center, Texas, United States
Disclosure information not submitted.
Nisha Rathi, MD
Associate Professor
The University of Texas MD Anderson Cancer Center, United States
Disclosure information not submitted.
.jpg "Kristen Price, MD, FCCP photo")
Kristen Price, MD, FCCP
Chair, Department of Critical Care and Respiratory Care
The University of Texas MD Anderson Cancer Center
Houston, Texas, United States
Disclosure information not submitted.
Joseph Nates, MBA, MD
Professor, Deputy Chair, Director ICUs
University of Texas MD Anderson Center
Bellaire, Texas, United States
Disclosure information not submitted.
Title: Factors Associated with Mortality in Patients with Hematological Malignancies and Septic Shock
INTRODUCTION/HYPOTHESIS: Sepsis and septic shock are among the most common reasons for ICU admission in patients with hematological malignancies. This often results in prolonged and sometimes futile ICU stays. We aimed to identify patients' characteristics associated with worse clinical outcomes in order to identify patient cohorts who could benefit from earlier goals of care planning.
Methods: A retrospective study of critically ill patients with hematological malignancies and meeting the Sepsis-3 criteria for septic shock was conducted. We included consecutive patients admitted to the ICU between 04/01/2016-03/31/2019. The main outcomes were ICU resource utilization and mortality. A multivariable logistics regression model identified the independent predictors of 28-day mortality.
Results: We identified 459 eligible patients. The median age was 63 years (range, 18-89). The majority of patients were male (61%) and white (61%); their median BMI was 27 (15-57). The median Charlson comorbidity index was 5 (1-18). The most common malignancies were acute myeloid leukemia (43%), non-Hodgkin lymphoma (19%), and acute lymphocytic leukemia (12%). Most patients had relapsed or refractory disease (47%), 109 patients (24%) had a history of stem cell transplantation (80% allogenic), and 54% had neutropenia. The admission and maximum SOFA scores were 11 (4-21) and 14 (4-22), respectively. More than half of the patients (60%) required invasive mechanical ventilation, and the median days on the ventilator was 7 (0-77). Renal replacement therapy was used in 21% of the patients. The median days on vasopressors was 1.5 (0-41.5). The 28-day mortality was 67.7%. Factors associated with 28-day mortality were SOFA score on admission (OR=1.11; 95% CI, 1.03-1.20), respiratory failure (OR=3.12; 95% CI, 1.49-6.51), maximum lactate (OR=1.16; 95% CI, 1.10-1.22), aminoglycosides (OR=0.42; 95% CI, 0.26-0.69), serum albumin (OR=0.51; 95% CI, 0.31-0.86), and granulocyte colony-stimulating factor (G-CSF) (OR=0.40; 95% CI, 0.24-0.65).
Conclusions: In this cohort of critically ill hematological cancer patients with septic shock, severity of illness, respiratory failure, and higher serum lactate were associated with poor outcomes. In contrast, higher albumin, and the use of aminoglycosides and G-CSF were associated with better survival.