John Cuenca, MD (he/him/his)
Clinical Research Assistant
The University of Texas MD Anderson Cancer Center
Houston, Texas
Disclosure information not submitted.
Nirmala Manjappachar, MD
Internal Medicine Resident Physician
Anne Arundel Medical Center
Annapolis, MD
Disclosure information not submitted.
Mike Hernandez, MS
Sr Biostatistician
The University of Texas MD Anderson Cancer Center, United States
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: Risk Factors of Short-Term Mortality in Patients with Septic Shock and Solid Tumors
Introduction/Hypothesis: Adequate ICU resource utilization remains a healthcare priority. It is essential to recognize which patients will benefit from prolonged life support therapy, especially those with multiorgan failure and septic shock. We aimed to identify the predictors of mortality in solid tumor patients with septic shock.
Methods: A single-center cohort of patients with solid tumors and septic shock admitted to the intensive care unit (ICU) between 4/1/2016-3/31/2019. We used the Sepsis-3 criteria for septic shock. A multivariate logistics regression model was used to identify the predictors of 28-day mortality. Kaplan-Meier plots and log-rank tests were used to analyze survival in subgroups of interest. Continuous variables are reported as median and ranges.
Results: We included 271 patients. The overall median age was 62 years (19-94). Most patients were male (51%), and white (54%); their median body mass index was 27 (13-53). The median Charlson comorbidity index was 8 (2-16). Lung cancer was the most common malignancy (19%), followed by breast (8%), pancreatic (8%), and colon cancers (7%). Most patients had metastatic disease (85%), and 18.5% had neutropenia. The admission and maximum sequential organ dysfunction assessment scores were 9 (4-19) and 11 (4-24), respectively. Most of the patients developed respiratory failure (79%), and 140 (52%) required invasive mechanical ventilation. Renal replacement therapy was used in 13% of the patients. The 28-day mortality was 69.4%. The independent predictors of 28-day mortality were metastatic disease (OR: 3.17; 95% CI,1.43-7.03), respiratory failure (OR: 2.34; 95% CI, 1.15-4.74), elevated lactate (OR: 3.19; 95% CI, 1.90-5.36), and Eastern Cooperative Oncology Group performance scores of 3-4 (OR: 2.72; 95% CI, 1.33-5.57). The Hosmer-Lemeshow goodness-of-fit test suggested adequate model fit (χ2(df=8) =8.94; P=.348). The concordance index also suggested moderate to good discrimination (.7702).
Conclusions: Critically ill solid tumors patients with septic shock had poor short-term survival. Metastasis, poor performance status, high lactate, and concomitant acute respiratory failure were associated with 28-day mortality. Early goals-of-care discussions should be considered at the time of ICU referral in frail patients with metastatic disease and septic shock.