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Yvin E, Kouatchet A, Mokart D, Martin-Loeches I, Taccone FS, Pène F, Bauer PR, Séguin A, van de Louw A, Mabrouki A, Bredin S, Metaxa V, Klouche K, Montini L, Mehta S, Bruneel F, Lisboa T, Viana W, Pickkers P, Russell L, Rusinova K, Rello J, Barbier F, Clere-Jehl R, Lafarge A, Lemiale V, Mercat A, Azoulay E, Darmon M. Escalation of Oxygenation Modalities and Mortality in Critically Ill Immunocompromised Patient With Acute Hypoxemic Respiratory Failure: A Clustering Analysis of a Prospectively Multicenter, Multinational Dataset. Crit Care Med 2025; 53:e1055-e1065. [PMID: 40013850 DOI: 10.1097/ccm.0000000000006600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2025]
Abstract
OBJECTIVES Acute hypoxemic respiratory failure in immunocompromised patients remains the leading cause of admission to the ICU, with high case fatality. The response to the initial oxygenation strategy may be predictive of outcome. This study aims to assess the response to the evolutionary profiles of oxygenation strategy and the association with survival. DESIGN Post hoc analysis of EFRAIM study with a nonparametric longitudinal clustering technique (longitudinal K-mean). SETTING AND PATIENTS Multinational, observational prospective cohort study performed in critically ill immunocompromised patients admitted for an acute respiratory failure. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 1547 patients who did not require invasive mechanical ventilation (iMV) at ICU admission were included. Change in ventilatory support was assessed and three clusters of change in oxygenation modality over time were identified. Cluster A: 12.3% iMV requirement and high survival rate, n = 717 patients (46.3%); cluster B: 32.9% need for iMV, 97% ICU mortality, n = 499 patients (32.3%); and cluster C: 37.5% need for iMV, 0.3% ICU mortality, n = 331 patients (21.4%). These clusters demonstrated a high discrimination. After adjustment for confounders, clusters B and C were independently associated with need for iMV (odds ratio [OR], 9.87; 95% CI, 7.26-13.50 and OR, 19.8; 95% CI, 13.7-29.1). CONCLUSIONS This study identified three distinct highly performing clusters of response to initial oxygenation strategy, which reliably predicted the need for iMV requirement and hospital mortality.
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Affiliation(s)
- Elise Yvin
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Achille Kouatchet
- Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France
| | - Djamel Mokart
- Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO) and Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, St JamesHospital, Dublin, Ireland
- Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Frederic Pène
- Medical Intensive Care Unit, Hôpital Cochin, APHP, Centre & Université de Paris, Paris, France
| | - Philippe R Bauer
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Amélie Séguin
- Medical ICU, Nantes University Hospital, Nantes, France
| | - Andry van de Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA
| | - Asma Mabrouki
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Swann Bredin
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital, NHS Foundation Trust, London, United Kingdom
| | - Kada Klouche
- Medical Intensive Care Unit, Montpellier University Hospital, Montpellier, France
| | - Luca Montini
- Agostino Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sangeeta Mehta
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Fabrice Bruneel
- Medical-Surgical Intensive Care Unit, Andre Mignot Hospital, Versailles, France
| | - Tiago Lisboa
- Department of Intensive Care, Hospital Santa Rita, Santa Casa de Misericordia, Porte Allegre, Brazil
| | - William Viana
- Department of Intensive Care, Hospital Copa d'Or, Rio de Janeiro, Brazil
| | - Peter Pickkers
- The Department of Intensive Care Medicine (710), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lene Russell
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Katherina Rusinova
- Department of Anesthesiology and Intensive Care Medicine and Institute for Medical Humanities, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Jordi Rello
- Centro de Investigación Biomédica en Red en enfermedades respiratorias (Ciberes), Instituto Salud Carlos III, Barcelona, Spain
- Infectious Area, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Anesthesiology Department, CHU Nîmes, University of Nîmes-Montpellier, Nimes, France
| | - Francois Barbier
- Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France
| | - Raphael Clere-Jehl
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Antoine Lafarge
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Alain Mercat
- Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - Michael Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
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Vujaklija Brajkovic A, Kosuta I, Batur L, Sundalic S, Medic M, Vujevic A, Bielen L, Babel J. Patients admitted in the intensive care unit after solid organ or bone marrow transplantation: Retrospective cohort study. World J Transplant 2025; 15:98975. [PMID: 40104198 PMCID: PMC11612888 DOI: 10.5500/wjt.v15.i1.98975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 09/27/2024] [Accepted: 10/25/2024] [Indexed: 11/26/2024] Open
Abstract
BACKGROUND Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) revolutionized the survival and quality of life of patients with malignant diseases, various immunologic, and metabolic disorders or those associated with a significant impairment in a patient's quality of life. AIM To investigate admission causes and treatment outcomes of patients after SOT or HSCT treated in a medical intensive care unit (ICU). METHODS We conducted a single-center, retrospective epidemiological study in the medical ICU at the University Hospital Centre Zagreb, Croatia covering the period from January 1, 2018 to December 31, 2023. RESULTS The study included 91 patients with either SOT [28 patients (30.8%)] or HSCT [63 patients (69.2%)]. The median age was 56 (43.2-64.7) years, and 60.4% of the patients were male. Patients with SOT had more comorbidities than patients after HSCT [χ² (5, n = 141) = 18.513, P < 0.001]. Sepsis and septic shock were the most frequent reasons for admission, followed by acute respiratory insufficiency in patients following HSCT. Survival rate significantly differed between SOT and HSCT [χ² (1, n = 91) = 21.767, P < 0.001]. ICU survival was 57% in the SOT and 12.7 % in the HSCT group. The need for mechanical ventilation [χ² (1, n = 91) = 17.081, P < 0.001] and vasopressor therapy [χ² (1, n = 91) = 36.803, P < 0.001] was associated with survival. The necessity for acute renal replacement therapy did not influence patients' survival [χ² (1, n = 91) = 0.376, P = 0.54]. In the subgroup of patients with infection, 90% had septic shock, and the majority had positive microbiological samples, mostly Gram-negative bacteria. The ICU survival of patients with sepsis/septic shock cumulatively was 15%. The survival of SOT patients with sepsis/shock was 45%. CONCLUSION Patients with SOT or HSCT are frequently admitted to the ICU due to sepsis and septic shock. Despite advancements in critical care, the mortality rate of patients with refractory septic shock and multiorgan failure in this patient population is extremely high. Early recognition and timely ICU admittance might improve the outcome of patients, especially after HSCT.
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Affiliation(s)
- Ana Vujaklija Brajkovic
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Iva Kosuta
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Lucija Batur
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Sara Sundalic
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Marijana Medic
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Andro Vujevic
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
| | - Luka Bielen
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Jaksa Babel
- Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
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Secreto C, Morel B, Bisbal M, Pennors W, Pouliquen C, Albanese J, Leone M, Cerrano M, Servan L, Gonzalez F, Faucher M, Chow-Chine L, Sannini A, Mokart D. Prognostic Impact of Neutropenia Recovery and G-CSF Use in Onco-Hematological Neutropenic Patients Admitted to Intensive Care Unit for Acute Respiratory Failure: A Retrospective, Real World Analysis. Adv Ther 2025; 42:280-292. [PMID: 39520656 DOI: 10.1007/s12325-024-03029-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 10/09/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION The effect of neutropenia and the use of granulocyte colony-stimulating factor (G-CSF) in critically ill patients with cancer are controversial, notably in those with lung injury. Neutropenia recovery can be associated with an acute respiratory failure (ARF) requiring intensive care unit (ICU) admission, especially when G-CSF is administered. METHODS In a single-center retrospective study, we evaluated (1) the effect of neutropenia recovery on the 90-day mortality and (2) the impact of G-CSF use on the outcome of patients with cancer and neutropenia with ARF admitted to the ICU. RESULTS Among 1098 screened patients, 152 were neutropenic at ICU admission. The 90-day mortality was 44.7%. Factors independently associated with the 90-day mortality were invasive mechanical ventilation, ground-glass opacities and nodules on computed tomography scans, a disease in progression and the Simplified Acute Physiology Score (SAPS II) at ICU admission. The lack of neutropenia recovery during the ICU stay was associated with the 90-day mortality. Using G-CSF had no effect on the 90-day mortality or the neutropenia duration, but the PaO2:FiO2 ratio was significantly lower after neutropenia recovery in patients who received G-CSF. Thus, respiratory deterioration can occur in the neutropenia recovery period, potentially exacerbated by G-CSF. CONCLUSION Our study suggests that neutropenia recovery was associated with survival in critically ill patients with cancer and neutropenia with ARF admitted to ICU, and the G-CSF could worsen the respiratory parameters.
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Affiliation(s)
- Carolina Secreto
- Division of Hematology, Department of Oncology, A.O.U. Città Della Salute e della Scienza di Torino, Turin, Italy.
| | - Bastien Morel
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Magali Bisbal
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Wulfran Pennors
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Camille Pouliquen
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Jauffrey Albanese
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Medicine, Nord Hospital, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
| | - Marco Cerrano
- Division of Hematology, Department of Oncology, A.O.U. Città Della Salute e della Scienza di Torino, Turin, Italy
| | - Luca Servan
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Frédéric Gonzalez
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Marion Faucher
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Laurent Chow-Chine
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Antoine Sannini
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Djamel Mokart
- Department of Anesthesiology and Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
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Nates JL, Pène F, Darmon M, Mokart D, Castro P, David S, Povoa P, Russell L, Nielsen ND, Gorecki GP, Gradel KO, Azoulay E, Bauer PR. Septic shock in the immunocompromised cancer patient: a narrative review. Crit Care 2024; 28:285. [PMID: 39215292 PMCID: PMC11363658 DOI: 10.1186/s13054-024-05073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
Immunosuppressed patients, particularly those with cancer, represent a momentous and increasing portion of the population, especially as cancer incidence rises with population growth and aging. These patients are at a heightened risk of developing severe infections, including sepsis and septic shock, due to multiple immunologic defects such as neutropenia, lymphopenia, and T and B-cell impairment. The diverse and complex nature of these immunologic profiles, compounded by the concomitant use of immunosuppressive therapies (e.g., corticosteroids, cytotoxic drugs, and immunotherapy), superimposed by the breakage of natural protective barriers (e.g., mucosal damage, chronic indwelling catheters, and alterations of anatomical structures), increases the risk of various infections. These and other conditions that mimic sepsis pose substantial diagnostic and therapeutic challenges. Factors that elevate the risk of progression to septic shock in these patients include advanced age, pre-existing comorbidities, frailty, type of cancer, the severity of immunosuppression, hypoalbuminemia, hypophosphatemia, Gram-negative bacteremia, and type and timing of responses to initial treatment. The management of vulnerable cancer patients with sepsis or septic shock varies due to biased clinical practices that may result in delayed access to intensive care and worse outcomes. While septic shock is typically associated with poor outcomes in patients with malignancies, survival has significantly improved over time. Therefore, understanding and addressing the unique needs of cancer patients through a new paradigm, which includes the integration of innovative technologies into our healthcare system (e.g., wireless technologies, medical informatics, precision medicine), targeted management strategies, and robust clinical practices, including early identification and diagnosis, coupled with prompt admission to high-level care facilities that promote a multidisciplinary approach, is crucial for improving their prognosis and overall survival rates.
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Affiliation(s)
- Joseph L Nates
- Department of Critical Care Medicine, Division of Anesthesiology, Critical Care, and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frédéric Pène
- Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, France
| | - Michael Darmon
- Médecine Intensive et Réanimation, Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital and Paris University, Paris, France
| | - Djamel Mokart
- Critical Care Department, Institut Paoli Calmettes, Marseille, France
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Sascha David
- Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Pedro Povoa
- Intensive Care Unit 4, Dept of Intensive Care, Hospital de São Francisco Xavier, ULSLO, Lisbon, Portugal
- NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Lene Russell
- Dept. of Intensive Care Medicine, Copenhagen University Hospital Gentofte, Hellerup, Denmark
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nathan D Nielsen
- University of New Mexico Hospital, Lomas Ave, Albuquerque, NM, USA
| | | | - Kim O Gradel
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital and Paris University, Paris, France
| | - Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, 200 First Street S.W., Rochester, MN, 55905, USA.
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Sankaranarayanan SA, Yadav DN, Yadav S, Srivastava A, Pramatha SR, Kotagiri VR, Joshi H, Rengan AK. Tailoring Phage Nanosomes for Enhanced Theranostic Properties of Near Infrared Dyes. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2024. [PMID: 39074245 DOI: 10.1021/acs.langmuir.4c01010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
Near-infrared (NIR) phototherapies offer noninvasive, cost-effective solutions for treating tumors and microbial infections. However, organic NIR dyes commonly used suffer from solubility and stability issues requiring frequent dosing. We address this challenge by exploring the bacteriophage-mediated enhancement of NIR dye properties. Upon encapsulation within phage nanosomes, IR780 and Indocyanine green (ICG), with similar optical properties but distinct water solubility and exhibit enhanced UV-vis absorbance and photothermal transduction efficacy compared to liposomes. Experimental characterization corroborated with all-atom molecular dynamics simulations imprints the nanoscale structure, solubility, dynamics, and binding of these NIR dye molecules to the membrane and protein molecules present in Phage capsid. These NIR dye-loaded phage nanosomes, coencapsulated with mitoxantrone, demonstrate enhanced anticancer activity, and when combined with amphotericin B, these dye molecules exhibit superior photothermal effects against fungal infections. Our findings present a simple and efficient approach for tuning the photothermal performance of existing NIR dyes through a rational design for enhanced therapeutic outcomes.
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Affiliation(s)
| | | | - Saanya Yadav
- Department of Biotechnology, IIT Hyderabad, Kandi, Telangana 502284, India
| | - Aditya Srivastava
- Department of Biomedical Engineering, IIT Hyderabad, Kandi, Telangana 502284, India
| | | | | | - Himanshu Joshi
- Department of Biotechnology, IIT Hyderabad, Kandi, Telangana 502284, India
| | - Aravind Kumar Rengan
- Department of Biomedical Engineering, IIT Hyderabad, Kandi, Telangana 502284, India
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MacPhail A, Dendle C, Slavin M, Weinkove R, Bailey M, Pilcher D, McQuilten Z. Neutropenic Sepsis in the Intensive Care Unit: Differences in Clinical Profile and Outcomes According to the Cause of Neutropenia. Open Forum Infect Dis 2024; 11:ofae289. [PMID: 38868301 PMCID: PMC11168584 DOI: 10.1093/ofid/ofae289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/16/2024] [Indexed: 06/14/2024] Open
Abstract
Background Neutropenic sepsis frequently requires admission to an intensive care unit (ICU). Differences between subgroups of patients with neutropenic sepsis are not well characterized. Aims To investigate clinical outcomes among patients with neutropenic sepsis and hematological malignancy, metastatic solid cancer, or no cancer diagnosis. Methods Retrospective cohort study of all patients admitted to ICU in Australia or New Zealand between January 2000 and December 2022 with a primary admission diagnosis of sepsis and total white cell count <1.0 × 109 cells/L. Results We identified 8617 ICU admissions with neutropenic sepsis (hematological malignancy n = 4660; metastatic solid cancer n = 1034; no cancer n = 2800). Patients with hematological malignancy were younger (median, 61.5 years) with low rates of chronic comorbidities (4.7%) and were usually admitted to ICU from the ward (67.4%). Mechanical ventilation rates were 20.2% and in-hospital mortality was 30.6%. Patients with metastatic solid cancers were older (median, 66.3 years), with higher rates of chronic comorbidities (9.9%), and were usually admitted to the ICU from the emergency department (50.8%). Mechanical ventilation rates were 16.9% and in-hospital mortality was 42.4%. Patients with no documented cancer had highest rates of mechanical ventilation (41.7%) and mortality (46.3%). Neutropenia was independently associated with mortality among patients with solid cancers or no cancer but did not confer increased risk among patients with hematological malignancy (odds ratio, 0.98; 95% confidence interval, .90-1.06; P = .60). Conclusions Patients with neutropenic sepsis and hematological malignancy, metastatic solid cancer, or no cancer diagnosis constitute 3 distinct clinical groups. Management approaches should be tailored accordingly.
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Affiliation(s)
- Aleece MacPhail
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Monash Health, Clayton, Victoria, Australia
| | - Claire Dendle
- Department of Infectious Diseases, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert Weinkove
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
- Te Rerenga Ora Wellington Blood & Cancer Centre, Wellington Hospital, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, Wellington, New Zealand
| | - Michael Bailey
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Prahran, Victoria, Australia
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE), Prahran, Victoria, Australia
- The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, Prahran, Victoria, Australia
| | - Zoe McQuilten
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Haematology, Monash Health, Clayton, Victoria, Australia
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MacPhail A, Dendle C, Slavin M, Weinkove R, Bailey M, Pilcher D, McQuilten Z. Sepsis mortality among patients with haematological malignancy admitted to intensive care 2000-2022: a binational cohort study. Crit Care 2024; 28:148. [PMID: 38711155 PMCID: PMC11075186 DOI: 10.1186/s13054-024-04932-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Sepsis occurs in 12-27% of patients with haematological malignancy within a year of diagnosis. Sepsis mortality has improved in non-cancer patients in the last two decades, but longitudinal trends in patients with haematological malignancy are not well characterised. We aimed to compare outcomes, including temporal changes, in patients with and without a haematological malignancy admitted to ICU with a primary diagnosis of sepsis in Australia and New Zealand over the past two decades. METHODS We performed a retrospective cohort study of 282,627 patients with a primary intensive care unit (ICU) admission diagnosis of sepsis including 17,313 patients with haematological malignancy, admitted to 216 intensive care units (ICUs) in Australia or New Zealand between January 2000 and December 2022. Annual crude and adjusted in-hospital mortality were reported. Risk factors for in-hospital mortality were determined using a mixed methods logistic regression model and were used to calculate annual changes in mortality. RESULTS In-hospital sepsis mortality decreased in patients with haematological malignancy, from 55.6% (95% CI 46.5-64.6%) in 2000 to 23.1% (95% CI 20.8-25.5%) in 2021. In patients without haematological malignancy mortality decreased from 33.1% (95% CI 31.3-35.1%) to 14.4% (95% CI 13.8-14.8%). This decrease remained significant after adjusting for mortality predictors including age, SOFA score and comorbidities, as estimated by adjusted annual odds of in-hospital death. The reduction in odds of death was of greater magnitude in patients with haematological malignancy than those without (OR 0.954, 95% CI 0.947-0.961 vs. OR 0.968, 95% CI 0.966-0.971, p < 0.001). However, absolute risk of in-hospital mortality remained higher in patients with haematological malignancy. Older age, higher SOFA score, presence of comorbidities, and mechanical ventilation were associated with increased mortality. Leukopenia (white cell count < 1.0 × 109 cells/L) was not associated with increased mortality in patients with haematological malignancy (p = 0.60). CONCLUSIONS Sepsis mortality has improved in patients with haematological malignancy admitted to ICU. However, mortality remains higher in patients with haematological malignancy than those without.
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Affiliation(s)
- Aleece MacPhail
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Department of Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Claire Dendle
- Department of Infectious Diseases, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 246 Clayton Road, Clayton, VIC, 3004, Australia
| | - Monica Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Robert Weinkove
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
- Te Rerenga Ora Wellington Blood and Cancer Centre, Wellington Hospital, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, Wellington, 6021, New Zealand
| | - Michael Bailey
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - David Pilcher
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Prahran, VIC, 3004, Australia
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE), 101 High St Prahran, Victoria, 3001, Australia
- The Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Rd, Prahran, VIC, 3004, Australia
| | - Zoe McQuilten
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Department of Haematology, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia.
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8
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Royo-Cebrecos C, Laporte-Amargós J, Peña M, Ruiz-Camps I, Garcia-Vidal C, Abdala E, Oltolini C, Akova M, Montejo M, Mikulska M, Martín-Dávila P, Herrera F, Gasch O, Drgona L, Morales HMP, Brunel AS, García E, Isler B, Kern WV, Palacios-Baena ZR, de la Calle GM, Montero MM, Kanj SS, Sipahi OR, Calik S, Márquez-Gómez I, Marin JI, Gomes MZR, Hemmatii P, Araos R, Peghin M, Del Pozo JL, Yáñez L, Tilley R, Manzur A, Novo A, Carratalà J, Gudiol C. Pseudomonas aeruginosa Bloodstream Infections Presenting with Septic Shock in Neutropenic Cancer Patients: Impact of Empirical Antibiotic Therapy. Microorganisms 2024; 12:705. [PMID: 38674650 PMCID: PMC11051800 DOI: 10.3390/microorganisms12040705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
This large, multicenter, retrospective cohort study including onco-hematological neutropenic patients with Pseudomonas aeruginosa bloodstream infection (PABSI) found that among 1213 episodes, 411 (33%) presented with septic shock. The presence of solid tumors (33.3% vs. 20.2%, p < 0.001), a high-risk Multinational Association for Supportive Care in Cancer (MASCC) index score (92.6% vs. 57.4%; p < 0.001), pneumonia (38% vs. 19.2% p < 0.001), and infection due to multidrug-resistant P. aeruginosa (MDRPA) (33.8% vs. 21.1%, p < 0.001) were statistically significantly higher in patients with septic shock compared to those without. Patients with septic shock were more likely to receive inadequate empirical antibiotic therapy (IEAT) (21.7% vs. 16.2%, p = 0.020) and to present poorer outcomes, including a need for ICU admission (74% vs. 10.5%; p < 0.001), mechanical ventilation (49.1% vs. 5.6%; p < 0.001), and higher 7-day and 30-day case fatality rates (58.2% vs. 12%, p < 0.001, and 74% vs. 23.1%, p < 0.001, respectively). Risk factors for 30-day case fatality rate in patients with septic shock were orotracheal intubation, IEAT, infection due to MDRPA, and persistent PABSI. Therapy with granulocyte colony-stimulating factor and BSI from the urinary tract were associated with improved survival. Carbapenems were the most frequent IEAT in patients with septic shock, and the use of empirical combination therapy showed a tendency towards improved survival. Our findings emphasize the need for tailored management strategies in this high-risk population.
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Affiliation(s)
- Cristina Royo-Cebrecos
- Internal Medicine Department, Hospital Nostra Senyora de Meritxell, SAAS, AD700 Escaldes-Engordany, Andorra;
| | - Júlia Laporte-Amargós
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, 08907 Barcelona, Spain;
| | - Marta Peña
- Haematology Department, Institute Català d’Oncologia (ICO)–Hospital Duran i Reynals, IDIBELL, 08908 Barcelona, Spain;
| | - Isabel Ruiz-Camps
- Infectious Diseases Department, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic i Provincial, 08036 Barcelona, Spain;
| | - Edson Abdala
- Instituto do Cancer do Estado de São Paulo, Faculty of Medicine, Univesity of São Paulo, Sao Paulo 01246, Brazil;
| | - Chiara Oltolini
- Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, 06100 Ankara, Turkey;
| | - Miguel Montejo
- Infectious Diseases Unit, Cruces University Hospital, 48903 Bilbao, Spain;
| | - Malgorzata Mikulska
- Division of Infectious Diseases, Ospedale Policlinico San Martino, University of Genoa (DISSAL), 16132 Genoa, Italy;
| | - Pilar Martín-Dávila
- Infectious Diseases Department, Ramon y Cajal Hospital, 28034 Madrid, Spain;
| | - Fabián Herrera
- Infectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1430EFA, Argentina;
| | - Oriol Gasch
- Infectious Diseases Department, Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
| | - Lubos Drgona
- Oncohematology Department, National Cancer Institute, Comenius University, 81499 Bratislava, Slovakia;
| | | | - Anne-Sophie Brunel
- Infectious Diseases and Medicine Department, Lausanne University Hospital, CHUV, 1011 Lausanne, Switzerland;
| | - Estefanía García
- Haematology Department, Reina Sofía University Hospital-IMIBIC-UCO, 14004 Córdoba, Spain;
| | - Burcu Isler
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Education and Research Hospital, 34668 Istanbul, Turkey;
| | - Winfried V. Kern
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, University of Freiburg Medical Center, 79110 Freiburg, Germany;
| | - Zaira R. Palacios-Baena
- Unit of Infectious Diseases and Clinical Microbiology, Institute of Biomedicine of Seville (IBIS), Virgen Macarena University Hospital, 41013 Seville, Spain;
| | - Guillermo Maestr de la Calle
- Infectious Diseases Unit, Instituto de Investigación Hospital “12 de Octubre” (i + 12), School of Medicine, “12 de Octubre” University Hospital, Universidad Complutense, 28041 Madrid, Spain;
| | - Maria Milagro Montero
- Infectious Pathology and Antimicrobials Research Group (IPAR), Infectious Diseases Service, Hospital del Mar, Institut Hospital del Mar d’Investigations Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain;
| | - Souha S. Kanj
- Infectious Diseases Division, American University of Beirut Medical Center, Beirut 110236, Lebanon;
| | - Oguz R. Sipahi
- Faculty of Medicine, Ege University, 35040 Izmir, Turkey;
| | - Sebnem Calik
- Department of Infectious Diseases and Clinical Microbiology, University of Health Science Izmir Bozyaka Training and Research Hospital, 35170 Izmir, Turkey;
| | | | - Jorge I. Marin
- Infectious Diseases and Clinical Microbiology Department, Clínica Maraya, Manizales 170001-17, Colombia;
| | - Marisa Z. R. Gomes
- Hospital Federal dos Servidores do Estado, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro 20221-161, Brazil;
| | - Philipp Hemmatii
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, 10117 Berlin, Germany;
| | - Rafael Araos
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago de Chile 12461, Chile;
| | - Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria-ASST-Sette Laghi, 21100 Varese, Italy;
| | - Jose L. Del Pozo
- Infectious Diseases and Microbiology Unit, Navarra University Clinic, 31008 Pamplona, Spain;
| | - Lucrecia Yáñez
- Haematology Department, Marqués de Valdecilla University Hospital, 39008 Santander, Spain;
| | - Robert Tilley
- Microbiology Department, University Hospitals Plymouth NHS Trust, Plymouth PL6 8DH, UK;
| | - Adriana Manzur
- Infectious Diseases, Hospital Rawson, San Juan J5400, Argentina;
| | - Andrés Novo
- Haematology Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain;
| | - Jordi Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, 08907 Barcelona, Spain;
- Faculty of Medicine, Bellvitge Campus, University of Barcelona, carrer de la Feixa Llarga, s/n, 08907 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Carlota Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, 08907 Barcelona, Spain;
- Faculty of Medicine, Bellvitge Campus, University of Barcelona, carrer de la Feixa Llarga, s/n, 08907 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Infectious Diseases Unit, Catalan Institute of Oncology (ICO), Duran i Reynals Hospital, IDIBELL, 08908 Barcelona, Spain
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Azoulay E, Maertens J, Lemiale V. How I manage acute respiratory failure in patients with hematological malignancies. Blood 2024; 143:971-982. [PMID: 38232056 DOI: 10.1182/blood.2023021414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/29/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024] Open
Abstract
ABSTRACT Acute respiratory failure (ARF) is common in patients with hematological malignancies notably those with acute leukemia, myelodysplastic syndrome, or allogeneic stem cell transplantation. ARF is the leading reason for intensive care unit (ICU) admission, with a 35% case fatality rate. Failure to identify the ARF cause is associated with mortality. A prompt, well-designed diagnostic workup is crucial. The investigations are chosen according to pretest diagnostic probabilities, estimated by the DIRECT approach: D stands for delay, or time since diagnosis; I for pattern of immune deficiency; R and T for radiological evaluation; E refers to clinical experience, and C to the clinical picture. Thorough familiarity with rapid diagnostic tests helps to decrease the use of bronchoscopy with bronchoalveolar lavage, which can cause respiratory status deterioration in those patients with hypoxemia. A prompt etiological diagnosis shortens the time on unnecessary empirical treatments, decreasing iatrogenic harm and costs. High-quality collaboration between intensivists and hematologists and all crossdisciplinary health care workers is paramount. All oxygen delivery systems should be considered to minimize invasive mechanical ventilation. Treatment of the malignancy is started or continued in the ICU under the guidance of the hematologists. The goal is to use the ICU as a bridge to recovery, with the patient returning to the hematology ward in sufficiently good clinical condition to receive optimal anticancer treatment.
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Affiliation(s)
- Elie Azoulay
- Intensive Care Department, Saint-Louis University Hospital, Paris-Cité University, Paris, France
| | - Johan Maertens
- Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
- Department of Hematology, University Hospitals Leuven, Leuven, Belgium
| | - Virginie Lemiale
- Intensive Care Department, Saint-Louis University Hospital, Paris-Cité University, Paris, France
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Bosch-Compte R, Visa L, Rios A, Duran X, Fernández-Real M, Gomariz-Vilaldach G, Masclans JR. Prognostic factors in oncological patients with solid tumours requiring intensive care unit admission. Oncol Lett 2023; 26:525. [PMID: 37927417 PMCID: PMC10623089 DOI: 10.3892/ol.2023.14112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
The aim of the present study was to identify factors predicting in-hospital mortality in patients with cancer admitted to a medical Intensive Care Unit (ICU), and to evaluate their functional status and survival during follow-up at the oncology service in the initial 12 months after hospital discharge. A retrospective observational study was performed on 129 consecutive oncological patients with solid tumours admitted to the medical ICU of the Hospital del Mar (Barcelona, Spain) between January 2016 and June 2018. Demographics, and clinical data in-ICU and in-hospital mortality were recorded. Post-hospital discharge follow-up was also carried out. ICU and hospital mortality rates were 24% (n=31) and 40.3% (n=52), respectively. Sequential Organ Failure Assessment (SOFA) score (HR, 1.20; 95% CI, 1.01-1.42; P=0.037), neutropenia on admission (HR, 8.53; 95% CI, 2.15-33.82; P=0.002), metastatic disease (HR, 3.92; 95% CI, 1.82-8.45; P<0.001), need for invasive mechanical ventilation (HR, 5.78; 95% CI, 1.61-20.73; P=0.007), surgery during hospital admission (HR, 0.23; 95% CI, 0.09-0.61; P=0.003) and ICU stay (>48 h) (HR, 0.11; 95% CI, 0.04-0.29; P<0.001) were the independent risk factors for ICU mortality. Overall, 59.5% of the survivors had good functional status at hospital discharge and 28.7% of patients with cancer admitted to the ICU were alive 1 year after hospital discharge, most of them (85.7%) with good functional status (Eastern Cooperative Oncology Group 0-1). In conclusion, hospital mortality may be associated with SOFA score at ICU admission, the need for invasive mechanical ventilation, neutropenia and metastatic disease. Only 40% of patients with oncological disease admitted to the ICU died during their hospital stay, and >50% of the survivors presented good functional status at hospital discharge. Notably, 1 year after hospital discharge, 28.7% of patients were alive, most of them with a good functional status.
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Affiliation(s)
- Raquel Bosch-Compte
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
- Network Biomedical Research Center in Cancer, Ministry of Science and Innovation, Government of Spain, 28029 Madrid, Spain
| | - Alejandro Rios
- Department of Medical Oncology, Hospital del Mar, 08003 Barcelona, Spain
| | - Xavier Duran
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Maria Fernández-Real
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Gemma Gomariz-Vilaldach
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
| | - Joan Ramon Masclans
- Department of Critical Care Medicine, Hospital del Mar, 08003 Barcelona, Spain
- Hospital del Mar Medical Research Institute Foundation, 08003 Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University, 08002 Barcelona, Spain
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Machine Learning-Based Mortality Prediction Model for Critically Ill Cancer Patients Admitted to the Intensive Care Unit (CanICU). Cancers (Basel) 2023; 15:cancers15030569. [PMID: 36765528 PMCID: PMC9913129 DOI: 10.3390/cancers15030569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although cancer patients are increasingly admitted to the intensive care unit (ICU) for cancer- or treatment-related complications, improved mortality prediction remains a big challenge. This study describes a new ML-based mortality prediction model for critically ill cancer patients admitted to ICU. PATIENTS AND METHODS We developed CanICU, a machine learning-based 28-day mortality prediction model for adult cancer patients admitted to ICU from Medical Information Mart for Intensive Care (MIMIC) database in the USA (n = 766), Yonsei Cancer Center (YCC, n = 3571), and Samsung Medical Center in Korea (SMC, n = 2563) from 2 January 2008 to 31 December 2017. The accuracy of CanICU was measured using sensitivity, specificity, and area under the receiver operating curve (AUROC). RESULTS A total of 6900 patients were included, with a 28-day mortality of 10.2%/12.7%/36.6% and a 1-year mortality of 30.0%/36.6%/58.5% in the YCC, SMC, and MIMIC-III cohort. Nine clinical and laboratory factors were used to construct the classifier using a random forest machine-learning algorithm. CanICU had 96% sensitivity/73% specificity with the area under the receiver operating characteristic (AUROC) of 0.94 for 28-day, showing better performance than current prognostic models, including the Acute Physiology and Chronic Health Evaluation (APACHE) or Sequential Organ Failure Assessment (SOFA) score. Application of CanICU in two external data sets across the countries yielded 79-89% sensitivity, 58-59% specificity, and 0.75-0.78 AUROC for 28-day mortality. The CanICU score was also correlated with one-year mortality with 88-93% specificity. CONCLUSION CanICU offers improved performance for predicting mortality in critically ill cancer patients admitted to ICU. A user-friendly online implementation is available and should be valuable for better mortality risk stratification to allocate ICU care for cancer patients.
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12
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Cantón-Bulnes ML, Jiménez-Sánchez M, Alcántara-Carmona S, Gimeno-Costa R, Berezo-García JÁ, Beato C, Álvarez-Lerma F, Mojal S, Olaechea P, Gordo-Vidal F, Garnacho-Montero J. Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study. Med Intensiva 2022; 46:669-679. [PMID: 36442913 DOI: 10.1016/j.medine.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/07/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To analyze clinical features associated to mortality in oncological patients with unplanned admission to the Intensive Care Unit (ICU), and to determine whether such risk factors differ between patients with solid tumors and those with hematological malignancies. DESIGN An observational study was carried out. SETTING A total of 123 Intensive Care Units across Spain. PATIENTS All cancer patients with unscheduled admission due to acute illness related to the background oncological disease. INTERVENTIONS None. MAIN VARIABLES Demographic parameters, severity scores and clinical condition were assessed, and mortality was analyzed. Multivariate binary logistic regression analysis was performed. RESULTS A total of 482 patients were included: solid cancer (n=311) and hematological malignancy (n=171). Multivariate regression analysis showed the factors independently associated to ICU mortality to be the APACHE II score (OR 1.102; 95% CI 1.064-1.143), medical admission (OR 3.587; 95% CI 1.327-9.701), lung cancer (OR 2.98; 95% CI 1.48-5.99) and mechanical ventilation after the first 24h of ICU stay (OR 2.27; 95% CI 1.09-4.73), whereas no need for mechanical ventilation was identified as a protective factor (OR 0.15; 95% CI 0.09-0.28). In solid cancer patients, the APACHE II score, medical admission, antibiotics in the previous 48h and lung cancer were identified as independent mortality indicators, while no need for mechanical ventilation was identified as a protective factor. In the multivariate analysis, the APACHE II score and mechanical ventilation after 24h of ICU stay were independently associated to mortality in hematological cancer patients, while no need for mechanical ventilation was identified as a protective factor. Neutropenia was not identified as an independent mortality predictor in either the total cohort or in the two subgroups. CONCLUSIONS The risk factors associated to mortality did not differ significantly between patients with solid cancers and those with hematological malignancies. Delayed intubation in patients requiring mechanical ventilation might be associated to ICU mortality.
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Affiliation(s)
- M L Cantón-Bulnes
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
| | - M Jiménez-Sánchez
- Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Seville, Spain
| | | | - R Gimeno-Costa
- Intensive Care Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - J Á Berezo-García
- Intensive Care Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - C Beato
- Medical Oncology Department, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - F Álvarez-Lerma
- Intensive Care Unit, Hospital del Mar - Parc de Salut Mar, Barcelona, Spain
| | - S Mojal
- Bioestadístico, Barcelona, Spain
| | - P Olaechea
- Hospital Universitario Galdakao-Usansolo, Biocruces Bizkaia Health Research Institute, Galdácano, Vizcaya, Spain
| | - F Gordo-Vidal
- Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain; Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - J Garnacho-Montero
- Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain
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Cuenca JA, Manjappachar NK, Ramírez CM, Hernandez M, Martin P, Gutierrez C, Rathi N, Sprung CL, Price KJ, Nates JL. Outcomes and Predictors of 28-Day Mortality in Patients With Solid Tumors and Septic Shock Defined by Third International Consensus Definitions for Sepsis and Septic Shock Criteria. Chest 2022; 162:1063-1073. [PMID: 35644244 PMCID: PMC9808606 DOI: 10.1016/j.chest.2022.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/27/2022] [Accepted: 05/16/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Data assessing outcomes of patients with solid tumors demonstrating septic shock using the Third International Consensus Definitions for Sepsis and Septic Shock are scarce. RESEARCH QUESTION What are the independent predictors of 28-day mortality in critically ill adults with solid tumors and septic shock? STUDY DESIGN AND METHODS Cohort of solid tumor patients admitted to the ICU with septic shock. Demographic and clinical characteristics were gathered from the electronic health records. We developed a reduced multivariate logistics regression model to identify independent predictors of 28-day mortality and used Kaplan-Meier plots to assess survival. RESULTS A total of 271 patients were included. The median age was 62 years (range, 19-94 years); 57.2% were men and 53.5% were White. The most common underlying malignancies were lung (19.2%), breast (7.7%), pancreatic (7.7%), and colorectal (7.4%) cancers. Most patients (84.5%) harbored metastatic disease. Twenty-eight days after ICU admission, 188 patients (69.4%) had died. Nonsurvivors showed a higher rate of advanced cancer, longer hospital stays before ICU admission, and higher Sequential Organ Failure Assessment scores at admission and throughout the ICU stay (P < .001 for all). The multivariate analysis identified metastatic disease (OR, 3.17; 95% CI, 1.43-7.03), respiratory failure (OR, 2.34; 95% CI, 1.15-4.74), elevated lactate levels (OR, 3.19; 95% CI, 1.90-5.36), and Eastern Cooperative Oncology Group performance scores of 3 or 4 (OR, 2.72; 95% CI, 1.33-5.57) as independent predictors of 28-day mortality. Only 38 patients (14%) were discharged home without medical assistance. INTERPRETATION The 28-day mortality rate of patients with solid tumors and septic shock was considerably high. Factors associated with worse survival included advanced oncologic disease, poor performance status, high lactate level, and concomitant acute respiratory failure. Early goals-of-care discussions should be considered for frail patients with septic shock and advanced metastatic disease without denying access to the appropriate level of care.
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Affiliation(s)
- John A Cuenca
- Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nirmala K Manjappachar
- Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Claudia M Ramírez
- Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mike Hernandez
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peyton Martin
- Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cristina Gutierrez
- Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nisha Rathi
- Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles L Sprung
- Department of Anesthesiology, Critical Care Medicine and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kristen J Price
- Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joseph L Nates
- Division of Anesthesiology, Critical Care, and Pain Medicine, Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
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15
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Prognostic Impact of Neutropenia in Cancer Patients with Septic Shock: A 2009–2017 Nationwide Cohort Study. Cancers (Basel) 2022; 14:cancers14153601. [PMID: 35892860 PMCID: PMC9332608 DOI: 10.3390/cancers14153601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary The prognostic impact of neutropenia on mortality in cancer patients with septic shock remains controversial despite recent advances in cancer and sepsis management. This study aimed to determine whether neutropenia could be related to an increase in short-term and long-term mortality. This population-based, case–control study used data from the National Health Insurance Service of Korea. Adult cancer patients who presented to the emergency department with septic shock from 2009 to 2017 were analyzed. The 30-day and 1-year mortality rates were evaluated as short-term and long-term outcomes. After adjustment for confounders, neutropenia was independently associated with decreased 30-day and 1-year mortality rates. Neutropenia did not increase mortality in cancer patients with septic shock, suggesting that neutropenia may not be used as a single triage criterion for withholding intensive care in cancer patients presenting to the emergency department with septic shock. Abstract (1) Background: Neutropenia’s prognostic impact on mortality in cancer patients with septic shock remains controversial despite recent advances in cancer and sepsis management. This population-based, case–control study aimed to determine whether neutropenia could be related to an increase in short-term and long-term mortality. (2) Methods: This population-based, case–control study used data from the National Health Insurance Service of Korea. Adult cancer patients who presented to the emergency department with septic shock from 2009 to 2017 were included. The 30-day and 1-year mortality rates were evaluated as short-term and long-term outcomes. Cox proportional hazard regression was performed after adjusting for age, sex, Charlson comorbidity index, and neutropenia. (3) Results: In 43,466 adult cancer patients with septic shock, the 30-day and 1-year mortality rates were 52.1% and 81.3%, respectively. In total, 6391 patients had neutropenic septic shock, and the prevalent cancer type was lung cancer, followed by leukemia, non-Hodgkin’s lymphoma, stomach cancer, and colon cancer. Furthermore, 30-day and 1-year mortality was lower in patients with neutropenia than in those without neutropenia. After adjustment for confounders, neutropenia was independently associated with decreased 30-day and 1-year mortality rates. (4) Conclusions: In cancer patients presenting to the emergency department with septic shock, the presence of neutropenia did not increase mortality. This suggests that neutropenia may not be used as a single triage criterion for withholding intensive care in cancer patients presenting to the emergency department with septic shock.
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Hematology Emergencies in Adults With Critical Illness. Chest 2022; 162:120-131. [DOI: 10.1016/j.chest.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
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Coudroy R, Frat JP, Ehrmann S, Pène F, Decavèle M, Terzi N, Prat G, Garret C, Contou D, Gacouin A, Bourenne J, Girault C, Vinsonneau C, Dellamonica J, Labro G, Jochmans S, Herbland A, Quenot JP, Devaquet J, Benzekri D, Vivier E, Nseir S, Colin G, Thevenin D, Grasselli G, Bougon D, Assefi M, Guérin C, Lherm T, Kouatchet A, Ragot S, Thille AW, Delphine C, Anne V, Florence B, Faustine R, Maeva R, Florent J, François A, Victor DR, René R, Laetitia BC, Charlotte SG, Emmanuelle M, Paul J, Nathalie M, Marine P, Morgane F, Suela D, Alexandre D, Clara C, Anaïs D, Florian S, Vanessa JM, Raphaël LM, Pierre B, Amélie S, Jean-Baptiste L, Emmanuel C, Gaëtan P, Radj C, Joanna T, Adel M, Benoit P, Julien C, Marc G, Gaëtan B, Dorothée C, Dominique M, Mehdi M, Clément S, Nicolas M, Pauline S, Quentin L, Pascal A, David C, Mai Anh N. High-flow nasal oxygen alone or alternating with non-invasive ventilation in critically ill immunocompromised patients with acute respiratory failure: a randomised controlled trial. THE LANCET RESPIRATORY MEDICINE 2022; 10:641-649. [DOI: 10.1016/s2213-2600(22)00096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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Manjappachar NK, Cuenca JA, Ramírez CM, Hernandez M, Martin P, Reyes MP, Heatter AJ, Gutierrez C, Rathi N, Sprung CL, Price KJ, Nates JL. Outcomes and Predictors of 28-Day Mortality in Patients With Hematologic Malignancies and Septic Shock Defined by Sepsis-3 Criteria. J Natl Compr Canc Netw 2022; 20:45-53. [PMID: 34991066 DOI: 10.6004/jnccn.2021.7046] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
| | - John A Cuenca
- 1Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
| | - Claudia M Ramírez
- 1Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
| | - Mike Hernandez
- 2Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Peyton Martin
- 1Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
| | - Maria P Reyes
- 1Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
| | - Alba J Heatter
- 1Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
| | - Cristina Gutierrez
- 1Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
| | - Nisha Rathi
- 1Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
| | - Charles L Sprung
- 3Department of Anesthesiology, Critical Care Medicine and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kristen J Price
- 1Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
| | - Joseph L Nates
- 1Department of Critical Care, Division of Anesthesiology, Critical Care, and Pain, and
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Impact of empirical antibiotic regimens on mortality in neutropenic patients with bloodstream infection presenting with septic shock. Antimicrob Agents Chemother 2021; 66:e0174421. [PMID: 34843387 DOI: 10.1128/aac.01744-21] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: We analyzed risk factors for mortality in febrile neutropenic patients with bloodstream infections (BSI) presenting with septic shock and assessed the impact of empirical antibiotic regimens. Methods: Multicenter retrospective study (2010-2019) of two prospective cohorts comparing BSI episodes in patients with or without septic shock. Multivariate analysis was performed to identify independent risk factors for mortality in episodes with septic shock. Results: Of 1563 patients with BSI, 257 (16%) presented with septic shock. Those patients with septic shock had higher mortality than those without septic shock (55% vs 15%, p<0.001). Gram-negative bacilli caused 81% of episodes with septic shock; gram-positive cocci, 22%; and Candida species 5%. Inappropriate empirical antibiotic treatment (IEAT) was administered in 17.5% of septic shock episodes. Empirical β-lactam combined with other active antibiotics was associated with the lowest mortality observed. When amikacin was the only active antibiotic, mortality was 90%. Addition of empirical specific gram-positive coverage had no impact on mortality. Mortality was higher when IEAT was administered (76% vs 51%, p=0.002). Age >70 years (OR 2.3, 95% CI 1.2-4.7), IEAT for Candida spp. or gram-negative bacilli (OR 3.8, 1.3-11.1), acute kidney injury (OR 2.6, 1.4-4.9) and amikacin as the only active antibiotic (OR 15.2, 1.7-134.5) were independent risk factors for mortality, while combination of β-lactam and amikacin was protective (OR 0.32, 0.18-0.57). Conclusions: Septic shock in febrile neutropenic patients with BSI is associated with extremely high mortality, especially when IEAT is administered. Combination therapy including an active β-lactam and amikacin results in the best outcomes.
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Haddad S, Jabbour JF, Hindy JR, Makki M, Sabbagh A, Nayfeh M, Boustany M, El-Zein S, Tamim H, Zakhem AE, El Cheikh J, Bazarbachi A, Kanj SS. Bacterial bloodstream infections and patterns of resistance in patients with haematological malignancies at a tertiary centre in Lebanon over 10 years. J Glob Antimicrob Resist 2021; 27:228-235. [PMID: 34607062 DOI: 10.1016/j.jgar.2021.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Bacterial bloodstream infections (BSIs) with resistant pathogens in patients with haematological malignancies are rising due to increased use of novel chemotherapeutic agents and prophylactic antibiotics. Our goal was to understand the epidemiology and resistance patterns of bacterial pathogens in patients with haematological malignancies to help tailor empirical antibiotics and to limit resistance. METHODS This was a retrospective chart review looking at bacterial BSI episodes between 2007-2017 in patients previously diagnosed with haematological malignancy at a tertiary-care centre in Lebanon. RESULTS Among 165 hospitalised patients with haematological malignancy and bacterial BSI over 10 years, Gram-negative bacteria (GNB) caused 65.0% of all episodes, with the most common pathogens being Escherichia coli (45.6%), 79.6% of which were ESBL-producers, Pseudomonas aeruginosa (7.5%) and Acinetobacter baumannii (4.0%). The majority of the organisms (61.0%) were multidrug-resistant (MDR), with ANC < 100 neutrophils/μL (OR = 0.12, 95% CI 0.03-0.54) identified as an independent marker for increased multidrug resistance. The risk factors associated with increased mortality included recent use of amikacin (p<0.001) and infections with organisms resistant to amikacin (p<0.001) or ciprofloxacin (p=0.04). Our results reflect a persistent pattern of Gram-negative predominance with E. coli remaining the most common isolated pathogen in bacterial BSIs in patients with haematological malignancies. The relative frequency of GNB to Gram-positive bacteria remains similar to our data from 2007. CONCLUSION The persistent divergence between worldwide data and the results observed in our centre and the increasing rates of MDR pathogens emphasise the importance of tailoring empirical antimicrobial therapy according to the centre's epidemiology.
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Affiliation(s)
- Sara Haddad
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean-Francois Jabbour
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joya-Rita Hindy
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maha Makki
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Sabbagh
- American University of Beirut, Beirut, Lebanon
| | | | | | - Saeed El-Zein
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aline El Zakhem
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jean El Cheikh
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Bazarbachi
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.
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Determinants of mortality in cancer patients with unscheduled admission to the Intensive Care Unit: A prospective multicenter study. Med Intensiva 2021. [DOI: 10.1016/j.medin.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Van de Louw A. Kinetics of blood neutrophil and lymphocyte count in critically ill neutropenic patients with hematological malignancies. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:321. [PMID: 34461972 PMCID: PMC8406906 DOI: 10.1186/s13054-021-03740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S Hershey Medical Center, 500 University Dr, Hershey, PA, USA.
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Changes in peripheral perfusion index during intraoperative end-expiratory occlusion tests do not predict the response to fluid administration in patients undergoing lung protective ventilation. J Anesth 2021; 35:837-843. [PMID: 34414489 DOI: 10.1007/s00540-021-02988-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/14/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The end-expiratory occlusion test (EEOT) may predict the response to fluid administration in patients undergoing lung-protective ventilation, but arterial catheter insertion is necessary to evaluate changes in stroke volume (SV). The peripheral perfusion index is a potential noninvasive alternative to evaluate SV. The aim of this study is to investigate whether changes in perfusion index during an intraoperative EEOT can predict the response to fluid administration in patients undergoing lung-protective ventilation (tidal volume 7 ml/kg predicted body weight). METHODS Forty-one elective surgical patients were enrolled. The SV and perfusion index were recorded before (baseline), during a 40-s EEOT and after volume expansion (250 ml of lactated Ringer's solution over 10 min). Patients with an increase in SV greater than 10% after volume expansion were defined as responders. ΔPI (change in perfusion index between baseline and 20 (ΔPI20) or 40 s (ΔPI40) after the beginning of EEOT were calculated using: ΔPI20 (%) = [(PI at 20 s after EEOT beginning - PIbaseline)/PIbaseline] × 100, ΔPI40 (%) = [(PI at 40 s after EEO beginning - PIbaseline)/PIbaseline] × 100). RESULTS Sixteen patients were responders, and 25 were non-responders. The area under the receiver operating characteristics curves generated for ΔPI20 and ΔPI40 to predict response to a fluid challenge were 0.561 (95% CI 0.374-0.749) and 0.688 (95% CI 0.523-0.852), respectively. CONCLUSION Changes in perfusion index during intraoperative EEOT in patients undergoing lung-protective ventilation (7 ml/kg) were unable to predict the response to fluid administration.
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Guck D, Ismail-Sayed I, Van de Louw A. Characteristics and prognosis of patients with myelodysplastic syndromes admitted to the intensive care unit. Leuk Lymphoma 2021; 62:3057-3059. [PMID: 34212820 DOI: 10.1080/10428194.2021.1948039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Daniel Guck
- Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Ibrahim Ismail-Sayed
- Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Andry Van de Louw
- Division of Pulmonary and Critical Care Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
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Awad WB, Nazer L, Elfarr S, Abdullah M, Hawari F. A 12-year study evaluating the outcomes and predictors of mortality in critically ill cancer patients admitted with septic shock. BMC Cancer 2021; 21:709. [PMID: 34130642 PMCID: PMC8207763 DOI: 10.1186/s12885-021-08452-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Though sepsis is common in patients with cancer, there are limited studies that evaluated sepsis and septic shock in this patient population. The objective of this study was to evaluate the outcomes and to identify predictors of mortality in cancer patients admitted to the intensive care unit (ICU) with septic shock. Methods This was a retrospective study conducted at a medical-surgical oncologic ICU of a comprehensive cancer center. Adult cancer patients admitted with septic shock between January 1, 2008 and December 31, 2019 were enrolled. Septic shock was defined as an ICU admission diagnosis of sepsis that required initiating vasopressors within 24 h of admission. Patient baseline characteristics, ICU length of stay and ICU and hospital mortality were recorded. Univariate analysis and logistic regression were performed to identify predictors associated with ICU and hospital mortality. Results During the study period, 1408 patients met the inclusion criteria. The mean age was 56.8 ± 16.1 (SD) years and mean Acute Physiology and Chronic Health Evaluation (APACHE) II was 23.0 ± 7.91 (SD). Among the enrolled patients, 67.8% had solid tumors while the remaining had hematological malignancies. Neutropenia and thrombocytopenia were reported in 19.3 and 39.5% of the patients, respectively, and mechanical ventilation was required for 42% of the patients. Positive cultures were reported in 836 (59.4%) patients, most commonly blood (33%) and respiratory (26.6%). Upon admission, about half the patients had acute kidney injury, while elevated total bilirubin and lactic acid levels were reported in 13.8 and 65.2% of the patients, respectively. The median ICU length of stay was 4 days (IQR 3–8), and ICU and hospital mortality were reported in 688 (48.9%) and 914 (64.9%) patients, respectively. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significantly associated with both ICU and hospital mortality. Conclusions In a relatively large cohort of patients with solid and hematological malignancies admitted to the ICU with septic shock, hospital mortality was reported in about two-third of the patients. Mechanical ventilation, APACHE II, thrombocytopenia, positive cultures, elevated bilirubin and lactic acid levels were significant predictors of mortality.
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Affiliation(s)
- Wedad B Awad
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
| | - Lama Nazer
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Salam Elfarr
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Maha Abdullah
- Department of Pharmacy, King Hussein Cancer Center, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Feras Hawari
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
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Xiang L, Wang H, Fan S, Zhang W, Lu H, Dong B, Liu S, Chen Y, Wang Y, Zhao L, Fu L. Machine Learning for Early Warning of Septic Shock in Children With Hematological Malignancies Accompanied by Fever or Neutropenia: A Single Center Retrospective Study. Front Oncol 2021; 11:678743. [PMID: 34211848 PMCID: PMC8240637 DOI: 10.3389/fonc.2021.678743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/21/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The purpose of this article was to establish and validate clinically applicable septic shock early warning model (SSEW model) that can identify septic shock in hospitalized children with onco-hematological malignancies accompanied with fever or neutropenia. METHODS Data from EMRs were collected from hospitalized pediatric patients with hematological and oncological disease at Shanghai Children's Medical Center. Medical records of patients (>30 days and <19 years old) with fever (≥38°C) or absolute neutrophil count (ANC) below 1.0 × 109/L hospitalized with hematological or oncological disease between January 1, 2017 and August 1, 2019 were considered. Patients in whom septic shock was diagnosed during the observation period formed the septic shock group, whereas non-septic-shock group was the control group. In the septic shock group, the time points at 4, 8, 12, and 24 hours prior to septic shock were taken as observation points, and corresponding observation points were obtained in the control group after matching. We employed machine learning artificial intelligence (AI) to filter features and used XGBoost algorithm to build SSEW model. Area under the ROC curve (AU-ROC) was used to compare the effectiveness among the SSEW Model, logistic regression model, and pediatric sequential organ failure score (pSOFA) for early warning of septic shock. MAIN RESULTS A total of 64 observation periods in the septic shock group and 2191 in the control group were included. AU-ROC of the SSEW model had higher predictive value for septic shock compared with the pSOFA score (0.93 vs. 0.76, Z = -2.73, P = 0.006). Further analysis showed that the AU-ROC of the SSEW model was superior to the pSOFA score at the observation points 4, 8, 12, and 24 h before septic shock. At the 24 h observation point, the SSEW model incorporated 14 module root features and 23 derived features. CONCLUSION The SSEW model for hematological or oncological pediatric patients could help clinicians to predict the risk of septic shock in patients with fever or neutropenia 24 h in advance. Further prospective studies on clinical application scenarios are needed to determine the clinical utility of this AI model.
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Affiliation(s)
- Long Xiang
- Department of Pediatrics Intensive Care Unit, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Artificial Intelligence Clinical Application and Research Center, Shanghai, China
| | - Hansong Wang
- Pediatric Artificial Intelligence Clinical Application and Research Center, Shanghai, China
- Shanghai Engineering Research Center of Intelligence, Shanghai, China
- Child Health Advocacy Institute, China Hospital Development Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Shujun Fan
- Medical Affairs, Shanghai Synyi Medical Technology CO., Ltd, Shanghai, China
| | - Wenlan Zhang
- Department of Pediatrics Intensive Care Unit, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Artificial Intelligence Clinical Application and Research Center, Shanghai, China
| | - Hua Lu
- Department of Pediatrics Intensive Care Unit, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Artificial Intelligence Clinical Application and Research Center, Shanghai, China
| | - Bin Dong
- Pediatric Artificial Intelligence Clinical Application and Research Center, Shanghai, China
- Shanghai Engineering Research Center of Intelligence, Shanghai, China
| | - Shijian Liu
- Child Health Advocacy Institute, China Hospital Development Institute of Shanghai Jiao Tong University, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Yiwei Chen
- Medical Affairs, Shanghai Synyi Medical Technology CO., Ltd, Shanghai, China
| | - Ying Wang
- Department of Pediatrics Intensive Care Unit, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Pediatric Artificial Intelligence Clinical Application and Research Center, Shanghai, China
| | - Liebin Zhao
- Pediatric Artificial Intelligence Clinical Application and Research Center, Shanghai, China
- Shanghai Engineering Research Center of Intelligence, Shanghai, China
- Child Health Advocacy Institute, China Hospital Development Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Lijun Fu
- Pediatric Artificial Intelligence Clinical Application and Research Center, Shanghai, China
- Department of Cardiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Sepsis and Septic Shock in Patients With Malignancies: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study. Crit Care Med 2021; 48:822-829. [PMID: 32317596 DOI: 10.1097/ccm.0000000000004322] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Cancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades. DATA SOURCE Seven European ICUs. STUDY SELECTION A hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors for day 30 mortality. DATA EXTRACTION Data from cancer patients admitted to ICUs for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994-2015). DATA SYNTHESIS Overall, 2,062 patients (62% men, median [interquartile range] age 59 yr [48-67 yr]) were included in the study. Underlying malignancies were solid tumors (n = 362; 17.6%) or hematologic malignancies (n = 1,700; 82.4%), including acute leukemia (n = 591; 28.7%), non-Hodgkin lymphoma (n = 461; 22.3%), and myeloma (n = 244; 11.8%). Two-hundred fifty patients (12%) underwent allogeneic hematopoietic stem cell transplantation and 640 (31.0%) were neutropenic at ICU admission. Day 30 mortality was 39.9% (823 deaths). The year of ICU admission was associated with significant decrease in day 30 mortality over time (odds ratio, 0.96; 95% CI, 0.93-0.98; p = 0.001). Mechanical ventilation (odds ratio, 3.25; 95% CI, 2.52-4.19; p < 0.01) and vasopressors use (odds ratio, 1.42; 95% CI, 1.10-1.83; p < 0.01) were independently associated with day 30 mortality, whereas underlying malignancy, allogeneic hematopoietic stem cell transplantation, and neutropenia were not. CONCLUSIONS Survival in critically ill oncology and hematology patients with sepsis improved significantly over time. As outcomes improve, clinicians should consider updating admission policies and goals of care in this population.
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Mackintosh D, Way M, Reade MC, Dhanani J. Short- and long-term outcomes of neutropenic cancer patients in intensive care according to requirement for invasive ventilation. Intern Med J 2021; 50:603-611. [PMID: 31841270 DOI: 10.1111/imj.14721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neutropenic fever is a frequently encountered complication when caring for cancer patients and can lead to intensive care admission, with high mortality rates in those patients who require invasive mechanical ventilation (IMV). Although hospital survival in this population has improved, long-term outcomes of critically ill neutropenic cancer patients have not been well defined. AIMS To evaluate short- and long-term outcomes of neutropenic cancer patients admitted to intensive care, according to requirement for invasive ventilation. Additionally, we aimed to determine predictors of poor clinical outcomes in this group. METHODS A retrospective cohort study of neutropenic cancer patients admitted to our intensive care unit (ICU) from 2008 to 2016. RESULTS We included 192 cancer patients of whom 100 (52.1%) required IMV. Overall ICU mortality was 29.7% and 12-month post-ICU mortality was 61.5%. Patients requiring IMV had significantly higher short- and long-term mortality (P < 0.001). Multivariate analysis determined three variables to be predictors of mortality at ICU discharge in the whole cohort: IMV (OR 13.52), renal replacement therapy (RRT, OR 2.37) and higher APACHE II scores (OR 1.1 for each unit increase). These variables were identical in the subgroup requiring invasive ventilation, with RRT (OR 2.76) and APACHE II scores (OR 1.1 for each unit increase) predicting short-term mortality. CONCLUSION Neutropenic cancer patients admitted to ICU have lower short-term mortality than previously reported in cohort studies, however their mortality rises significantly following discharge from ICU. Those patients who require IMV are at significantly increased risk of both short- and long-term mortality.
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Affiliation(s)
- David Mackintosh
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Mandy Way
- Department of Biostatistics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Michael C Reade
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Jayesh Dhanani
- Department of Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
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Fei Q, Chen HB, Zhang CM, Xu JJ, He X, Chen SW. The efficacy and safety of gemcitabine-based induction chemotherapy for locally advanced nasopharyngeal carcinoma treated with concurrent chemoradiation: A meta-analysis. Medicine (Baltimore) 2021; 100:e25398. [PMID: 33832134 PMCID: PMC8036042 DOI: 10.1097/md.0000000000025398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/15/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To assess the efficacy and toxicity of gemcitabine-based induction chemotherapy followed by concurrent chemoradiotherapy (CCRT) in locally advanced nasopharyngeal carcinoma (LA-NPC). METHODS Both observational studies (OBS) and randomized controlled trials (RCT) were included in the meta-analysis. Systematic online searches were conducted in Web of Sciences, PubMed, Embase, meeting proceedings and ClinicalTrials.gov from the inception to May 25, 2020. The primary endpoint of interest was overall survival. RESULTS five OBSs and 2 RCTs including 1680 patients were incorporated in the analysis. The evidence from the RCTs showed that adding gemcitabine-based induction chemotherapy to CCRT significantly improved progression free survival (hazard ratio (HR): 0.60, 95% confidence interval (CI): 0.40-0.88; P = .010; chi square P = .25; I2 = 24%) and overall survival (HR: 0.47; 95% CI: 0.28-0.80; P = 0.005; chi square P = .49, I2 = 0%) and was related to a higher risk of hematological toxicities. Furthermore, based on the data of OBSs, overall survival (HR: 0.52; 95% CI: 0.31-0.88; P = .02; chi square P = .37, I2 = 6%) was significantly improved in patients treated with gemcitabine-based induction chemotherapy compared to those treated with taxane-based induction chemotherapy. However, the progression free survival (HR: 0.67; 95% CI: 0.45-1.01; P = .06; chi square P = .74; I2 = 0%) showed no significant difference. CONCLUSIONS For LA-NPC patients, adding gemcitabine-based induction chemotherapy to CCRT significantly improved overall survival and progression free survival with a higher risk of hematological toxicities when compared to CCRT alone. Also, gemcitabine-based regimen could be used as an alternative induction chemotherapy regimen to taxane-based regimen in the treatment of LA-NPC.
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Affiliation(s)
- Qian Fei
- Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Han-Bo Chen
- The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, 42 Bai Zi Ting Road, Nanjing, Jiangsu, China
| | - Chun-Mei Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Jia-Jun Xu
- Nanjing First Hospital, Nanjing Medical University, Nanjing
| | - Xia He
- The Affiliated Cancer Hospital of Nanjing Medical University and Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, 42 Bai Zi Ting Road, Nanjing, Jiangsu, China
| | - Song-Wang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing
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Bacterial Infection among Cancer Patients: Analysis of Isolates and Antibiotic Sensitivity Pattern. Int J Microbiol 2021; 2021:8883700. [PMID: 33510793 PMCID: PMC7825358 DOI: 10.1155/2021/8883700] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/03/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Cancer patients being immunosuppressed are vulnerable to develop infections. Knowledge of the changing epidemiology of infections has a pivotal role in its management. Aims and Objectives. The study is undertaken to assess the types of bacterial infections in cancer patients undergoing anticancer treatment, the associated bacterial pathogens, and their antibiotic sensitivity patterns. Materials and Methods A retrospective surveillance study was undertaken in our center. Positive culture reports and other clinical details of cancer patients diagnosed with infection during a stay in the tertiary care center from 1st January 2015 to 31st December 2016 were analysed by descriptive statistical methods chi-square test and odds ratio to study the association. Results Out of 638 cancer patients diagnosed with infections in the 2-year period, 140 patients had positive cultures, representing 272 specimens and 306 isolates. Common specimens sent for culture were blood sputum, urine, and pus. 214 isolates (69.9%) were gram-negative bacilli, and 92 (30.1%) were gram-positive cocci. The most common isolates were Klebsiella spp. (18.30%), Pseudomonas spp. (17.65%), and Escherichia coli (14.71%) followed by Staphylococcus aureus (13.72%). Among the gram-negative organisms, the antibiotic resistance rates reported to fluoroquinolones, aminoglycosides, and third-generation cephalosporins were 45.13%, 39.20%, and 48.58%, respectively. 26.92% of the organisms are resistant to all three antibiotics. 50.4% of Klebsiella spp. and Escherichia coli were ESBL producers. Gram-negative organisms showed 11.63% resistance to β-lactam/β-lactamase inhibitor combination, and 22.22% of gram-negative organisms are resistant to carbapenems. 50% of the Staphylococcus spp. were methicillin resistant, but all were sensitive to vancomycin. Conclusion The surge in the number of gram-negative infections emphasizes the need for broad-spectrum empirical therapy targeting the same. Rate of resistance of the isolated gram-negative organisms to the routinely used empirical therapy is alarming. Prudent use of antibiotics, based on culture reports wherever possible, is of utmost importance to save the lives of infected patients and prevent further development of antibiotic resistance.
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Li Y, Dubick MA, Yang Z, Barr JL, Gremmer BJ, Lucas ML, Necsoiu C, Jordan BS, Batchinsky AI, Cancio LC. Distal organ inflammation and injury after resuscitative endovascular balloon occlusion of the aorta in a porcine model of severe hemorrhagic shock. PLoS One 2020; 15:e0242450. [PMID: 33201908 PMCID: PMC7671515 DOI: 10.1371/journal.pone.0242450] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/03/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) has emerged as a potential life-saving maneuver for the management of non-compressible torso hemorrhage in trauma patients. Complete REBOA (cREBOA) is inherently associated with the burden of ischemia reperfusion injury (IRI) and organ dysfunction. However, the distal organ inflammation and its association with organ injury have been little investigated. This study was conducted to assess these adverse effects of cREBOA following massive hemorrhage in swine. METHODS Spontaneously breathing and consciously sedated Sinclair pigs were subjected to exponential hemorrhage of 65% total blood volume over 60 minutes. Animals were randomized into 3 groups (n = 7): (1) Positive control (PC) received immediate transfusion of shed blood after hemorrhage, (2) 30min-cREBOA (A30) received Zone 1 cREBOA for 30 minutes, and (3) 60min-cREBOA (A60) given Zone 1 cREBOA for 60 minutes. The A30 and A60 groups were followed by resuscitation with shed blood post-cREBOA and observed for 4h. Metabolic and hemodynamic effects, coagulation parameters, inflammatory and end organ consequences were monitored and assessed. RESULTS Compared with 30min-cREBOA, 60min-cREBOA resulted in (1) increased IL-6, TNF-α, and IL-1β in distal organs (kidney, jejunum, and liver) (p < 0.05) and decreased reduced glutathione in kidney and liver (p < 0.05), (2) leukopenia, neutropenia, and coagulopathy (p < 0.05), (3) blood pressure decline (p < 0.05), (4) metabolic acidosis and hyperkalemia (p < 0.05), and (5) histological injury of kidney and jejunum (p < 0.05) as well as higher levels of creatinine, AST, and ALT (p < 0.05). CONCLUSION 30min-cREBOA seems to be a feasible and effective adjunct in supporting central perfusion during severe hemorrhage. However, prolonged cREBOA (60min) adverse effects such as distal organ inflammation and injury must be taken into serious consideration.
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Affiliation(s)
- Yansong Li
- Department of Expeditionary Critical Care Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
- * E-mail:
| | - Michael A. Dubick
- Department of Damage Control Resuscitation, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Zhangsheng Yang
- Department of Expeditionary Critical Care Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Johnny L. Barr
- Department of Damage Control Resuscitation, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Brandon J. Gremmer
- Department of Expeditionary Critical Care Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Michael L. Lucas
- Department of Expeditionary Critical Care Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Corina Necsoiu
- Department of Expeditionary Critical Care Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Bryan S. Jordan
- Department of Expeditionary Critical Care Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Andriy I. Batchinsky
- Department of Expeditionary Critical Care Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Leopoldo C. Cancio
- U. S. Army Burn Center, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
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Cortegiani A, Grasselli G. Exploring Associations Between Respiratory Mechanics and Survival in Immunocompromised Patients With ARDS. Chest 2020; 158:1812-1813. [DOI: 10.1016/j.chest.2020.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
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Martos-Benítez FD, Soler-Morejón CDD, Lara-Ponce KX, Orama-Requejo V, Burgos-Aragüez D, Larrondo-Muguercia H, Lespoir RW. Critically ill patients with cancer: A clinical perspective. World J Clin Oncol 2020; 11:809-835. [PMID: 33200075 PMCID: PMC7643188 DOI: 10.5306/wjco.v11.i10.809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/09/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
Cancer patients account for 15% of all admissions to intensive care unit (ICU) and 5% will experience a critical illness resulting in ICU admission. Mortality rates have decreased during the last decades because of new anticancer therapies and advanced organ support methods. Since early critical care and organ support is associated with improved survival, timely identification of the onset of clinical signs indicating critical illness is crucial to avoid delaying. This article focused on relevant and current information on epidemiology, diagnosis, and treatment of the main clinical disorders experienced by critically ill cancer patients.
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Affiliation(s)
| | | | | | | | | | | | - Rahim W Lespoir
- Intensive Care Unit 8B, Hermanos Ameijeiras Hospital, Havana 10300, Cuba
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Acute respiratory failure in immunocompromised patients: outcome and clinical features according to neutropenia status. Ann Intensive Care 2020; 10:146. [PMID: 33090310 PMCID: PMC7581668 DOI: 10.1186/s13613-020-00764-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background The impact of neutropenia in critically ill immunocompromised patients admitted in a context of acute respiratory failure (ARF) remains uncertain. The primary objective was to assess the prognostic impact of neutropenia on outcomes of these patients. Secondary objective was to assess etiology of ARF according to neutropenia. Methods We performed a post hoc analysis of a prospective multicenter multinational study from 23 ICUs belonging to the Nine-I network. Between November 2015 and July 2016, all adult immunocompromised patients with ARF admitted to the ICU were included in the study. Adjusted analyses included: (1) a hierarchical model with center as random effect; (2) propensity score (PS) matched cohort; and (3) adjusted analysis in the matched cohort. Results Overall, 1481 patients were included in this study of which 165 had neutropenia at ICU admission (11%). ARF etiologies distribution was significantly different between neutropenic and non-neutropenic patients, main etiologies being bacterial pneumonia (48% vs 27% in neutropenic and non-neutropenic patients, respectively). Initial oxygenation strategy was standard supplemental oxygen in 755 patients (51%), high-flow nasal oxygen in 165 (11%), non-invasive ventilation in 202 (14%) and invasive mechanical ventilation in 359 (24%). Before adjustment, hospital mortality was significantly higher in neutropenic patients (54% vs 42%; p = 0.006). After adjustment for confounder and center effect, neutropenia was no longer associated with outcome (OR 1.40, 95% CI 0.93–2.11). Similar results were observed after matching (52% vs 46%, respectively; p = 0.35) and after adjustment in the matched cohort (OR 1.04; 95% CI 0.63–1.72). Conclusion Neutropenia at ICU admission is not associated with hospital mortality in this cohort of critically ill immunocompromised patients admitted for ARF. In neutropenic patients, main ARF etiologies are bacterial and fungal infections.
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Linko-Parvinen AM, Turkia H. Reporting Sysmex XN Absolute Neutrophil Count in Samples with Leukocyte Analyzer Flagging. Lab Med 2020; 52:168-173. [PMID: 32816034 DOI: 10.1093/labmed/lmaa058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To provide faster laboratory data reporting, we evaluated the accuracy of Sysmex XN (Sysmex Inc, Kobe, Japan) absolute neutrophil count (ANC) in the presence of analyzer flagging. METHODS Sysmex XN and manual microscopy ANC were compared with 80 autovalidated control specimens and with 280 study specimens with analyzer flagging regarding immature granulocytes (IG) >3% or other leukocyte abnormalities. Specimens with ambiguous neutrophil clusters were excluded. RESULTS A slight positive overall method bias was seen for Sysmex XN compared to manual microscopy (n = 280), 0.025 (95% confidence interval [CI], -0.023 to 0.069) × 109/L. With IG > 10% (n = 123) the bias was larger, but not clinically significant, 0.17 (95% CI, 0.060-0.25) × 109/L. No clinically significant difference was seen in neutropenic (ANC < 1.5 × 109/L) specimens (n = 91), 0.070 (95% CI, -0.013 to 0.14) × 109/L. CONCLUSION These data indicate that Sysmex XN ANC can be reported in the presence of certain analyzer flagging to improve patient care.
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Affiliation(s)
| | - Heidi Turkia
- Laboratory of Haematology, Tykslab, Laboratory Division, Turku University Hospital, Turku, Finland
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Lucas A, Yasa J, Lucas M. Regeneration and repair in the healing lung. Clin Transl Immunology 2020; 9:e1152. [PMID: 32665845 PMCID: PMC7338595 DOI: 10.1002/cti2.1152] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/26/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
The lung achieves an efficient gas exchange between a complex non‐sterile atmosphere and the body via a delicate and extensive epithelial surface, with high efficiency because of elastic deformation allowing for an increase and decrease in volume during the process of breathing and because of an extensive vasculature which aids rapid gas diffusion. The lungs’ large surface area exposes the organ to a continual risk of damage from pathogens, toxins or irritants; however, lung damage can be rapidly healed via regenerative processes that restore its structure and function. In response to sustained and extensive damage, the lung is healed via a non‐regenerative process resulting in scar tissue which locally stiffens its structure, which over time leads to a serious loss of lung function and to increasing morbidities. This review discusses what is known about the factors which influence whether a lung is healed by regeneration or repair and what potential new therapeutic approaches may positively influence lung healing.
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Affiliation(s)
- Andrew Lucas
- School of Biomedical Sciences The University of Western Australia (UWA) Perth WA Australia
| | - Joe Yasa
- Centre for Cell Therapy and Regenerative Medicine School of Medicine and Pharmacology The University of Western Australia (UWA) Perth WA Australia
| | - Michaela Lucas
- School of Biomedical Sciences The University of Western Australia (UWA) Perth WA Australia.,School of Medicine and Pharmacology The University of Western Australia (UWA) Perth WA Australia
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Demoule A, Antonelli M, Schellongowski P, Pickkers P, Soares M, Meyhoff T, Rello J, Bauer PR, van de Louw A, Lemiale V, Grimaldi D, Martin-Loeches I, Balik M, Mehta S, Kouatchet A, Barratt-Due A, Valkonen M, Reignier J, Metaxa V, Moreau AS, Burghi G, Mokart D, Mayaux J, Darmon M, Azoulay E. Respiratory Mechanics and Outcomes in Immunocompromised Patients With ARDS: A Secondary Analysis of the EFRAIM Study. Chest 2020; 158:1947-1957. [PMID: 32569634 DOI: 10.1016/j.chest.2020.05.602] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/06/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In view of the high mortality rate of immunocompromised patients with ARDS, it is important to identify targets for improvement. RESEARCH QUESTION This study investigated factors associated with mortality in this specific ARDS population, including factors related to respiratory mechanics (plateau pressure [Pplat,rs], compliance [Crs], and driving pressure [ΔPrs]). STUDY DESIGN AND METHODS This study consisted of a predefined secondary analysis of the EFRAIM data. Overall, 789 of 1,611 patients met the Berlin criteria for ARDS, and Pplat,rs, ΔPrs, and Crs were available for 494 patients. A hierarchical model was used to assess factors at ARDS onset independently associated with hospital mortality. RESULTS Hospital mortality was 56.3%. After adjustment, variables independently associated with hospital mortality included ARDS of undetermined etiology (OR, 1.66; 95% CI, 1.01-2.72), need for vasopressors (OR, 1.91; 95% CI, 1.27-2.88), and need for renal replacement therapy (OR, 2.02; 95% CI, 1.37-2.97). ARDS severity according to the Berlin definition, neutropenia on admission, and the type of underlying disease were not significantly associated with mortality. Before adjustment, higher Pplat,rs, higher ΔPrs, and lower Crs were associated with higher mortality. Addition of each of these individual variables to the final hierarchical model revealed a significant association with mortality: ΔPrs (OR, 1.08; 95% CI, 1.05-1.12), Pplat,rs (OR, 1.07; 95% CI, 1.04-1.11), and Crs (OR, 0.97; 95% CI, 0.95-0.98). Tidal volume was not associated with mortality. INTERPRETATION In immunocompromised patients with ARDS, respiratory mechanics provide additional prognostic information to predictors of hospital mortality. Studies designed to define lung-protective ventilation guided by these physiological variables may be warranted in this specific population.
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Affiliation(s)
- Alexandre Demoule
- AP-HP Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
| | - Massimo Antonelli
- Department of Anesthesia, Intensive Care and Emergency Medicine, Fondazione Ospedale Universitario A. Gemelli IRCCS; Istituto di Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Peter Pickkers
- Department of Intensive Care Medicine (710), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Programa de Pós-Graduação em Clínica Médica, Rio De Janeiro, Brazil
| | - Tine Meyhoff
- Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jordi Rello
- CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients (ESGCIP), Barcelona, Spain
| | - Philippe R Bauer
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Andry van de Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA
| | - Virgine Lemiale
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical Epidemiology, UMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Paris Diderot Sorbonne University, Paris, France
| | - David Grimaldi
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO) and Department of Clinical Medicine, Trinity College, Wellcome Trust-HRB Clinical Research Facility, Caring for Critically Ill Immuno-compromised Patients Multinational Network (Nine-I). St James Hospital, Dublin, Ireland
| | - Martin Balik
- Department of Anesthesiology and Intensive Care, 1st Faculty of Medicine and General University Hospital, Charles University, Prague, Czech Republic
| | - Sangeeta Mehta
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Achille Kouatchet
- Department of Medical Intensive Care Medicine, University Hospital of Angers, Angers, France
| | - Andreas Barratt-Due
- Department of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Miia Valkonen
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jean Reignier
- Medical Intensive Care Unit, Hôtel Dieu-HME University Hospital of Nantes, Nantes, France
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital, NHS Foundation Trust, London, England
| | - Anne-Sophie Moreau
- Critical Care Center, CHU Lille, School of Medicine, University of Lille, Lille, France
| | - Gaston Burghi
- Terapia Intensiva, Hospital Maciel, Montevideo, Uruguay
| | - Djamel Mokart
- Réanimation Polyvalente et Département d'Anesthésie et de Réanimation, Institut Paoli-Calmettes, Marseille, France
| | - Julien Mayaux
- AP-HP Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Michael Darmon
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA
| | - Elie Azoulay
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA
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de Azambuja E, Trapani D, Loibl S, Delaloge S, Senkus E, Criscitiello C, Poortman P, Gnant M, Di Cosimo S, Cortes J, Cardoso F, Paluch-Shimon S, Curigliano G. ESMO Management and treatment adapted recommendations in the COVID-19 era: Breast Cancer. ESMO Open 2020; 5:e000793. [PMID: 32439716 PMCID: PMC7295852 DOI: 10.1136/esmoopen-2020-000793] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/22/2020] [Accepted: 04/26/2020] [Indexed: 01/06/2023] Open
Abstract
The global preparedness and response to the rapid escalation to severe acute respiratory syndrome coronavirus (SARS-CoV)-2-related disease (COVID-19) to a pandemic proportion has demanded the formulation of a reliable, useful and evidence-based mechanism for health services prioritisation, to achieve the highest quality standards of care to all patients. The prioritisation of high value cancer interventions must be embedded in the agenda for the pandemic response, ensuring that no inconsistency or discrepancy emerge in the health planning processes.The aim of this work is to organise health interventions for breast cancer management and research in a tiered framework (high, medium, low value), formulating a scheme of prioritisation per clinical cogency and intrinsic value or magnitude of benefit. The public health tools and schemes for priority setting in oncology have been used as models, aspiring to capture clinical urgency, value in healthcare, community goals and fairness, while respecting the principles of benevolence, non-maleficence, autonomy and justice.We discuss the priority health interventions across the cancer continuum, giving a perspective on the role and meaning to maintain some services (undeferrable) while temporarily abrogate some others (deferrable). Considerations for implementation and the essential link to pre-existing health services, especially primary healthcare, are addressed, outlining a framework for the development of effective and functional services, such as telemedicine.The discussion covers the theme of health systems strategising, and why oncology care, in particular breast cancer care, should be maintained in parallel to pandemic control measures, providing a pragmatic clinical model within the broader context of public healthcare schemes.
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Affiliation(s)
- Evandro de Azambuja
- Institut Jules Bordet and l'Université Libre de Bruxelles (U.LB), Brussels, Belgium
| | - Dario Trapani
- European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | | | - Suzette Delaloge
- Oncology, Gustave Roussy and Paris-Saclay University, Villejuif, Île-de-France, France
| | - Elzbieta Senkus
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Philip Poortman
- Iridium Kankernetwerk and University of Antwerp, Antwerp, Belgium
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - Javier Cortes
- IOB, Institute of Oncology, Quiron Group (Madrid & Barcelona); Vall d'Hebron institute of Oncology (VHIO) (Barcelona), Barcelona, Madrid, Spain
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Shani Paluch-Shimon
- Division of Oncology, Shaare Zedek Medical Centre, Jerusalem, Jerusalem, Israel
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano and European Institute of Oncology, IRCCS, Milano, Italy
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Probst L, Schalk E, Liebregts T, Zeremski V, Tzalavras A, von Bergwelt-Baildon M, Hesse N, Prinz J, Vehreschild JJ, Shimabukuro-Vornhagen A, Eichenauer DA, Garcia Borrega J, Kochanek M, Böll B. Prognostic accuracy of SOFA, qSOFA and SIRS criteria in hematological cancer patients: a retrospective multicenter study. J Intensive Care 2019; 7:41. [PMID: 31410290 PMCID: PMC6686367 DOI: 10.1186/s40560-019-0396-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background With Sepsis-3, the increase in sequential organ failure assessment (SOFA) as a clinical score for the identification of patients with sepsis and quickSOFA (qSOFA) for the identification of patients at risk of sepsis outside the intensive care unit (ICU) were introduced in 2016. However, their validity has been questioned, and their applicability in different settings and subgroups, such as hematological cancer patients, remains unclear. We therefore assessed the validity of SOFA, qSOFA, and the systemic inflammatory response syndrome (SIRS) criteria regarding the diagnosis of sepsis and the prediction of in-hospital mortality in a multicenter cohort of hematological cancer patients treated on ICU and non-ICU settings. Methods We retrospectively calculated SIRS, SOFA, and qSOFA scores in our cohort and applied the definition of sepsis as "life-threatening organ dysfunction caused by dysregulated host response to infection" as reference. Discriminatory capacity was assessed using the area under the receiver operating characteristic curve (AUROC). Results Among 450 patients with hematological cancer (median age 58 years, 274 males [61%]), 180 (40%) had sepsis of which 101 (56%) were treated on ICU. For the diagnosis of sepsis, sensitivity was 86%, 64%, and 42% for SIRS, SOFA, and qSOFA, respectively. However, the AUROCs of SOFA and qSOFA indicated better discrimination for sepsis than SIRS (SOFA, 0.69 [95% CI, 0.64-0.73] p < 0.001; qSOFA, 0.67 [95% CI, 0.62-0.71] p < 0.001; SIRS, 0.57 [95% CI, 0.53-0.61] p < 0.001).In-hospital mortality was 40% and 14% in patients with and without sepsis, respectively (p < 0.001). Regarding patients with sepsis, mortality was similar in patients with positive and negative SIRS scores (39% vs. 40% (p = 0.899), respectively). For patients with qSOFA ≥ 2, mortality was 49% compared to 33% for those with qSOFA < 2 (p = 0.056), and for SOFA 56% vs. 11% (p < 0.001), respectively. SOFA allowed significantly better discrimination for in-hospital mortality (AUROC 0.74 [95% CI, 0.69-0.79] p < 0.001) than qSOFA (AUROC 0.65 [95% CI, 0.60-0.71] p < 0.001) or SIRS (AUROC 0.49 [95% CI, 0.44-0.54] p < 0.001). Conclusions An increase in SOFA score of ≥ 2 had better prognostic accuracy for both diagnosis of sepsis and in-hospital mortality in this setting, and especially on ICU, we observed limited validity of SIRS criteria and qSOFA in identifying hematological patients with sepsis and at high risk of death.
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Affiliation(s)
- Lucie Probst
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Enrico Schalk
- 2Department of Hematology and Oncology, Otto-von-Guericke University, Magdeburg, Germany
| | - Tobias Liebregts
- 3Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Vanja Zeremski
- 2Department of Hematology and Oncology, Otto-von-Guericke University, Magdeburg, Germany
| | - Asterios Tzalavras
- 3Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Nina Hesse
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Johanna Prinz
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Jörg Janne Vehreschild
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany.,German Centre for Infection Research, partner-site Bonn-Cologne, Cologne, Germany.,6Medical Department 2, Hematology/Oncology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Alexander Shimabukuro-Vornhagen
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Dennis A Eichenauer
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Jorge Garcia Borrega
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Matthias Kochanek
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Boris Böll
- 1University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
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40
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Darmon M, Bourmaud A, Georges Q, Soares M, Jeon K, Oeyen S, Rhee CK, Gruber P, Ostermann M, Hill QA, Depuydt P, Ferra C, Toffart AC, Schellongowski P, Müller A, Lemiale V, Mokart D, Azoulay E. Changes in critically ill cancer patients' short-term outcome over the last decades: results of systematic review with meta-analysis on individual data. Intensive Care Med 2019; 45:977-987. [PMID: 31143998 DOI: 10.1007/s00134-019-05653-7] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/20/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The number of averted deaths due to therapeutic advances in oncology and hematology is substantial and increasing. Survival of critically ill cancer patients has also improved during the last 2 decades. However, these data stem predominantly from unadjusted analyses. The aim of this study was to assess the impact of ICU admission year on short-term survival of critically ill cancer patients, with special attention on those with neutropenia. METHODS Systematic review and meta-analysis of individual data according to the guidelines of meta-analysis of observational studies in epidemiology. DATASOURCE Pubmed and Cochrane databases. ELIGIBILITY CRITERIA Adult studies published in English between May 2005 and May 2015. RESULTS Overall, 7354 patients were included among whom 1666 presented with neutropenia at ICU admission. Median ICU admission year was 2007 (IQR 2004-2010; range 1994-2012) and median number of admissions per year was 693 (IQR 450-1007). Overall mortality was 47.7%. ICU admission year was associated with a progressive decrease in hospital mortality (OR per year 0.94; 95% CI 0.93-0.95). After adjustment for confounders, year of ICU admission was independently associated with hospital mortality (OR for hospital mortality per year: 0.96; 95% CI 0.95-0.97). The association was also seen in patients with neutropenia but not in allogeneic stem cell transplant recipients. CONCLUSION After adjustment for patient characteristics, severity of illness and clustering, hospital mortality decreased steadily over time in critically ill oncology and hematology patients except for allogeneic stem cell transplant recipients.
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Affiliation(s)
- Michaël Darmon
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France. .,Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France. .,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris, France.
| | - Aurélie Bourmaud
- Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,Public Health Department, Robert Debré University Hospital, AP-HP, Paris, France.,UMRS 1123, Clinical Epidemiology and Economic Evaluation Applied to Vulnerable Populations (Epidémiologie Clinique et Évaluation Économique appliquée aux Populations Vulnérables [ECEVE]), Paris Diderot University, Paris, France
| | - Quentin Georges
- Medical-Surgical ICU, Saint-Etienne University Hospital, Saint-Étienne, France
| | - Marcio Soares
- Department of Critical Care and Graduate Program in Translational Medicine, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sandra Oeyen
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Pascale Gruber
- Department of Critical Care, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
| | - Marlies Ostermann
- Department of Critical Care and Nephrology, King's College London, Guy's and St Thomas' NHS Foundation Hospital, London, UK
| | - Quentin A Hill
- Department of Haematology, Leeds Teaching Hospitals, Leeds, UK
| | - Pieter Depuydt
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Christelle Ferra
- Department of Clinical Hematology, ICO-Hospital Germans Trias i Pujol, Josep Carreras Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Anne-Claire Toffart
- Thoracic Oncology Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit 13i2, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alice Müller
- Universidade Federal do Rio Grande do Sul, Rio Grande do Sul, Porto Alegre, Brazil
| | - Virginie Lemiale
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France
| | - Djamel Mokart
- Anesthesiology and Intensive Care Unit, Institut Paoli Calmette, Marseille, France
| | - Elie Azoulay
- Medical ICU, Saint-Louis University Hospital, AP-HP, Paris, France.,Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,ECSTRA Team, Biostatistics and Clinical Epidemiology, UMR 1153 (Center of Epidemiology and Biostatistic Sorbonne Paris Cité, CRESS), INSERM, Paris, France
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41
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Kochanek M, Schalk E, von Bergwelt-Baildon M, Beutel G, Buchheidt D, Hentrich M, Henze L, Kiehl M, Liebregts T, von Lilienfeld-Toal M, Classen A, Mellinghoff S, Penack O, Piepel C, Böll B. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2019; 98:1051-1069. [PMID: 30796468 PMCID: PMC6469653 DOI: 10.1007/s00277-019-03622-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/17/2019] [Indexed: 02/06/2023]
Abstract
Sepsis and septic shock are major causes of mortality during chemotherapy-induced neutropenia for malignancies requiring urgent treatment. Thus, awareness of the presenting characteristics and prompt management is most important. Improved management of sepsis during neutropenia may reduce the mortality of cancer therapies. However, optimal management may differ between neutropenic and non-neutropenic patients. The aim of the current guideline is to give evidence-based recommendations for hematologists, oncologists, and intensive care physicians on how to manage adult patients with neutropenia and sepsis.
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Affiliation(s)
- Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany.
| | - E Schalk
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - M von Bergwelt-Baildon
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Medical Department III, University Medical Center & Comprehensive Cancer Center Munich, Munich, Germany
| | - G Beutel
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department for Hematology, Hemostasis, Oncology and Stem Cell Transplantation Hannover Medical School, Hannover, Germany
| | - D Buchheidt
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Hematology and Oncology, Mannheim University Hospital, Mannheim, Germany
| | - M Hentrich
- Department of Medicine III - Hematology and Oncology, Red Cross Hospital, Munich, Germany
| | - L Henze
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Medicine, Clinic III - Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - M Kiehl
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Internal Medicine I, Clinic Frankfurt (Oder), Frankfurt, Germany
| | - T Liebregts
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
- Department of Bone Marrow Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - M von Lilienfeld-Toal
- Department for Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | - A Classen
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - S Mellinghoff
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - O Penack
- Department for Hematology, Oncology and Tumorimmunology, Campus Virchow Clinic, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - C Piepel
- Department of Hematology, Oncology and Infectious Diseases, Klinikum Bremen-Mitte, Bremen, Germany
| | - B Böll
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Intensive Care in Hematologic and Oncologic Patients (iCHOP), Cologne, Germany
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