Abhishek Bhardwaj, MD, FACP
Cleveland Clinic Foundation
Cleveland, Ohio
Disclosure information not submitted.
Agam Bansal MD
Resident
Cleveland Clinic Foundation, Ohio, United States
Disclosure information not submitted.
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Ryota Sato, MD
Staff Intensivist
The Queens Medical Center
Honolulu, Hawaii
Disclosure information not submitted.
Abhijit Duggal, MD, MPH, MSc, FACP
Assistant Professor
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Siddharth Dugar, MD, FCCM
Associate Staff
Cleveland Clinic Foundation
Cleveland, Ohio
Disclosure information not submitted.
Simon Mucha, MD, FACP
Physician
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Title: Trends in In-Hospital Mortality of Patients Hospitalized with Septic Shock with Malignancy
Introduction: Over the last two decades, there is an improvement in survival after septic shock. It is unclear whether patients with history of malignancy who develop septic shock also have improvement in survival over time. We report the trend in survival over the last decade for patients with septic shock without malignancy and those with septic shock and malignancy.
Methods: Retrospective study analyzing trends in in-hospital mortality of patients with septic shock with and without malignancy from 2011 to 2020. Further, we determined the trends in mortality amongst the patients who had solid versus non-solid tumor malignancy over the past ten years. The in-hospital mortality across the groups was adjusted for the APACHE II score. Trend analysis was performed using the Mann Kendall test. All the statistical analysis was performed using R and p< 0.05 was considered statistically significant.
Results: Patients with septic shock admitted to Cleveland Clinic from 2011-2020 were included. 862 (25%) had a history of malignancy. The in-hospital mortality in patients with a history of malignancy was 41.1% (n=411) and in those with no history of malignancy was 33.84% (n=1019). Over the past ten years, there has been a significant improvement in in-hospital mortality in patients hospitalized with septic shock without a history of malignancy (2011: 46.11%, 2012: 36.87%, 2013: 35.67%, 2014: 36.97%, 2015: 32.63%, 2016: 32.76%, 2017: 33.85%, 2018: 30.87%, 2019: 29.71%, 2020: 27.50%, p< 0.001). However, there has not been a statistically significant improvement in patients with malignancy (2011: 53.20%, 2012: 42.20%, 2013: 43.21%, 2014: 43.00%, 2015: 34.50%, 2016: 40.86%, 2017: 41.59%, 2018: 38.65%, 2019: 38.69%, 2020: 42.50%, p=0.546). Similarly, there was no significant improvement in mortality amongst patients with solid-tumor malignancy (2011: 47.80% to 2020: 41.37%, p=0.913) and non-solid tumor (2011: 56% to 2020: 42.35%, p=0.393).
Conclusion: Over the past 10 years, there has been a significant improvement in in-hospital mortality amongst patients without malignancy who were hospitalized with septic shock. However, there has been no significant improvement in mortality amongst patients with malignancy. These findings have significant implications in guiding future investigations and goals of care discussion with families.