Lama Nazer, BCPS, PharmD, FCCM (she/her/hers)
Clinical Pharmacy Specialist
King Hussein Cancer Center
Amman, Jordan
Disclosure information not submitted.
Maria Lopez-Olivo, MD
Physician
The University of Texas MD Anderson Cancer Center, Texas, United States
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.
Aseel Abusara, PharmD
Pharmacist
King Hussein Cancer Center, United States
Disclosure information not submitted.
Wedad Awad, BCPS, PharmD
Critical Care Clinical Pharmacist
King Hussein Cancer Center
Amman, Jordan
Disclosure information not submitted.
Anne Rain Brown, PharmD, BCCCP, FCCM
Critical Care Clinical Pharmacy Specialist
University of Texas MD Anderson Center
Houston, Texas
Disclosure information not submitted.
Michael Sirimaturos, BCCCP, BCNSP, PharmD
Clinical Specialist Leader - Critical Care
Houston Methodist Hospital
Houston, Texas, United States
Disclosure information not submitted.
Rachel Hiklen, MSL
Medical Librarian
MD Anderson, 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: A systematic review evaluating mortality in critically ill cancer patients with sepsis
Introduction: Although sepsis is common in patients with cancer, there are limited studies that evaluated outcomes of critically ill patients with sepsis. In this review, we aimed to synthesize mortality rates and lengths of stay reported in cancer patients with sepsis treated in intensive care units (ICUs).
Methods: Three electronic databases were searched (MEDLINE, Embase, and CENTRAL) to identify studies published in English between January 2010 and December 2020. We included studies evaluating adult patients with sepsis, septic shock, or severe sepsis, as defined by the study investigators. We excluded studies that included pediatrics, those with >30% of hematopoietic stem cell transplant patients or post-surgical patients, and those that evaluated a specific stage of malignancy. Study selection, data extraction, and quality appraisal with the Newcastle-Ottawa Scale (NOS) were performed by two independent reviewers. We synthesized data on ICU, hospital, and 28-day mortality, as well as ICU length of stay.
Results: Among the 4,775 publications retrieved, 15 were eligible. Most studies were retrospective and single-centered. All studies had a NOS score ≥7. The studies had a total of 9,835 patients (5,164 with solid tumors, 4,671 with hematological malignancies), mean age ranged from 48-64 years old, and the majority were males (n=6,072, 62%). During the ICU stay, neutropenia was reported in 11%-57% of the patients, mechanical ventilation in 34%-88%, and the use of vasopressors in 18%-100%. The reported ICU mortality ranged between 30%-72% (11 studies), while hospital mortality and 28-day mortality were reported in 41%-79% (7 studies) and 40%-63% (5 studies), of the patients, respectively. The mean ICU length of stay ranged between 3 and 13 days.
Conclusion: In critically ill cancer patients with sepsis, mortality rates varied between studies, reaching as high as two-third of the patients dying prior to hospital discharge. Several factors may contribute to the differences between the studies, such as the individual study inclusion criteria, sepsis definitions used, characteristics of the patients, and the severity of illness. Large, multi-center studies are necessary to provide clinicians with a better understanding about the outcomes of critically ill cancer patients with sepsis.