Outcomes and Predictors of 28-Day Mortality in Patients With Hematologic Malignancies and Septic Shock Defined by Sepsis-3 Criteria

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  • 1 Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
  • | 2 Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
  • | 3 Department of Anesthesiology, Critical Care Medicine and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.

Background: To describe short-term outcomes and independent predictors of 28-dayx mortality in adult patients with hematologic malignancies and septic shock defined by the new Third International Consensus Definitions (Sepsis-3) criteria. Methods: We performed a retrospective cohort study of patients admitted to the medical ICU with septic shock from April 2016 to March 2019. Demographic and clinical features and short-term outcomes were collected. We used descriptive statistics to summarize patient characteristics, logistic regression to identify predictors of 28-day mortality, and Kaplan-Meier plots to assess survival. Results: Among the 459 hematologic patients with septic shock admitted to the ICU, 109 (23.7%) had received hematopoietic stem cell transplant. The median age was 63 years (range, 18–89 years), and 179 (39%) were women. Nonsurvivors had a higher Charlson comorbidity index (P=.007), longer length of stay before ICU admission (P=.01), and greater illness severity at diagnosis and throughout the hospital course (P<.001). The mortality rate at 28 days was 67.8% and increased with increasing sequential organ failure assessment score on admission (odds ratio [OR], 1.11; 95% CI, 1.03–1.20), respiratory failure (OR, 3.12; 95% CI, 1.49–6.51), and maximum lactate level (OR, 1.16; 95% CI, 1.10–1.22). Aminoglycosides administration (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) were associated with lower 28-day mortality. Life support limitations were present in 81.6% of patients at death. At 90 days, 19.4% of the patients were alive. Conclusions: Despite efforts to enhance survival, septic shock in patients with hematologic malignancies is still associated with high mortality rates and poor 90-day survival. These results demonstrate the need for an urgent call to action with higher awareness, including the further evaluation of interventions such as earlier ICU admission, aminoglycosides administration, and G-CSF treatment.

Submitted January 27, 2021; final revision received April 13, 2021; accepted for publication April 15, 2021.

Previous presentation: Preliminary data used in this study were presented as an abstract at the Society of Critical Care Medicine (SSCM) 49th Critical Care Congress; February 16–19, 2020; Orlando, Florida, and the SSCM 50th Critical Care Virtual Congress; January 31–February 12, 2021. Abstracts 614, 848, 886, and 1208.

Author contributions: Study concept and design: Manjappachar, Cuenca, Ramírez, Hernandez, Nates. Data integrity and analysis: Manjappachar, Cuenca, Ramírez, Hernandez, Nates. Data acquisition: Manjappachar, Cuenca, Ramírez. Data analysis: Manjappachar, Cuenca, Ramírez. Data interpretation: All authors. Formal statistical analysis: Cuenca, Hernandez, Nates. Administrative, technical, or material support: Cuenca, Hernandez, Martin, Reyes, Heatter, Price, Nates. Manuscript preparation: Manjappachar, Cuenca, Hernandez, Nates. Critical revision: All authors.

Disclosures: Dr. Rathi has reported serving on a data safety monitoring board for Cellenkos Inc. The remaining authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the George Sweeney Fellowship, The University of Texas MD Anderson Cancer Center Grant Resources, and the NCI of the NIH (number P30CA016672; J.L. Nates).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. None of the funders had any role in the conduct of the study; in the collection, management, analysis, or interpretation of the data; in the preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.

Correspondence: Joseph L. Nates, MD, MBA, CMQ, MCCM, Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit #112, Houston, TX 77030. Email: jlnates@mdanderson.org

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