John Cuenca, MD (he/him/his)
Clinical Research Assistant
The University of Texas MD Anderson Cancer 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.
Nirmala Manjappachar, MD
Internal Medicine Resident Physician
Anne Arundel Medical Center
Annapolis, MD
Disclosure information not submitted.
Peyton Martin, BS
Research Assistant
The University of Texas MD Anderson Cancer Center, Texas, United States
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.
Nisha Rathi, MD
Associate Professor
The University of Texas MD Anderson Cancer Center, 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.
Joseph Nates, MBA, MD
Professor, Deputy Chair, Director ICUs
University of Texas MD Anderson Center
Bellaire, Texas, United States
Disclosure information not submitted.
Title: Outcomes of Acute Kidney Injury in Hematological Cancer Patients with Septic Shock
INTRODUCTION/HYPOTHESIS: The incidence of acute kidney injury in patients with sepsis is approximately 53%. Hematological cancer patients with septic shock and AKI have been rarely studied. Therefore, we aimed to describe the incidence, ICU resource utilization, and mortality in this population.
Methods: Retrospective cohort of patients with hematological malignancies admitted to the ICU with septic shock between 4/1/2016-3/31/2019. Septic shock was diagnosed with the Sepsis-3 criteria. Patients who developed AKI during their ICU admission were compared to patients without AKI. Measured outcomes were organ support, length of stay (LOS), and mortality rates.
Results: Of 459 patients, 369 (80%) developed AKI. Patients with AKI were older (63 [53-71] vs 58 [41.8-68.3]; P=.009). There were no differences in sex, race, and performance status between the groups. The median BMI (27.5 [23.9-32.1] vs 26 [23-29.5]; P=.033) and Charlson comorbidity index (5 [4-7] vs 4 [3-6]; P=.033) were higher in AKI. Cancer status and history of stem cell transplant were also similar among the groups. Admission lactate (4.9 [2.9-9.4] vs 4.1 [2.5-5.8]; P=.001), admission SOFA (12 [9-14] vs 9 [7-11]; P< .001) and maximum SOFA (15 [12-17] vs 10 [8-12]; P< .001) scores were higher in the AKI patients. Patients with AKI required more invasive mechanical ventilation (65% vs 40%; P< .001). Nevertheless, days on the ventilator were not different (6.7 [2.3-13.9] vs 5.9 [3.1-11.2]; P=.726). Renal replacement therapy (RRT) was initiated in 26% of the AKI patients. Median ICU LOS was longer in AKI patients (6 [2-12.5] vs 3 [1-8]; P< .001). The median hospital LOS did not differ (22 [10-40.5] vs 20.5 [7-42]; P=.47). The ICU (67% vs 52%; P=.011), hospital (77% vs 61%; P=.002), and 90-day (84% vs 69%; P=.002) mortality rates were significantly higher in AKI patients.
Conclusion: Hematological cancer patients with septic shock have a high incidence of AKI, ICU resource utilization, and mortality rates. In this cohort, only one in five AKI patients survived their hospitalization, and one in four required RRT. Further research is needed to assess if earlier recognition with biomarkers, EHR-integrated early warning systems, and machine learning models could improve outcomes.