Research published by Manjappachar et al in JNCCN—Journal of the National Comprehensive Cancer Network examined the impact of septic shock on people with hematologic malignancies. They found that the mortality rate was 67.8% at 28 days, and only 19.4% of patients remained alive after 90 days.
The researchers studied 459 adult patients with hematologic cancers hospitalized for septic shock between April 1, 2016, and March 31, 2019. Survival was calculated from the date of intensive care unit (ICU) admission until the patient’s date of death or date of last follow-up. The study demonstrated significantly higher risk for this patient group compared to patients without cancer, for whom sepsis mortality rates have been falling over the past 20 years.
“Our results highlight the opportunity for increasing awareness of the lethality of septic shock among patients with cancer and how important it is to prevent it,” said senior researcher Joseph L. Nates, MD, MBA, CMQ, MCCM, of the Department of Critical Care at The University of Texas MD Anderson Cancer Center. “We must develop preventive strategies to reduce infection rates in patients with blood cancers and promote early detection of sepsis before it progresses to septic shock. We should also emphasize the early initiation of antibiotic therapy, appropriate monitoring techniques, and rational fluid resuscitation in such … patients with suspected infections.”
KEY POINTS
- The mortality rate was 67.8% at 28 days, and only 19.4% of patients remained alive after 90 days.
- Acute respiratory failure, elevated blood lactate, and multiorgan failure increased the probability of dying.
- Aminoglycoside administration, serum albumin, and receiving granulocyte colony–stimulating factor were associated with lower 28-day mortality.
- Patients who had an allogeneic stem cell transplant and subsequent graft-vs-host-disease had the lowest 90-day survival rate.
According to the findings, acute respiratory failure, elevated blood lactate, and multiorgan failure increased the probability of dying. Aminoglycoside administration, serum albumin, and receiving granulocyte colony–stimulating factor were associated with lower 28-day mortality. Patients who had an allogeneic stem cell transplant and subsequent graft-vs-host-disease had the lowest 90-day survival rate of about 4%.
“This study highlights the fact that despite advances in identification and treatment of patients with sepsis, the outcome remains very poor for patients with hematologic malignancies,” commented Sankar Swaminathan, MD, Don Merrill Rees Presidential Endowed Chair Chief of Infectious Diseases in the Department of Medicine at Huntsman Cancer Center-University of Utah Health, who was not involved with this research.
“The extremely high mortality of such patients admitted with septic shock is sobering and underscores the need for improved strategies to identify these patients early in the disease course. While the [National Comprehensive Cancer Network (NCCN)] Guidelines for Prevention and Treatment of Cancer-Related Infections utilize risk stratification to guide management, further research in this area is clearly needed,” he said.
Dr. Swaminathan, who is Vice-Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Prevention and Treatment of Cancer-Related Infections, continued, “The study also identified aspects of treatment that may be important in improving outcomes in septic shock in this population, such as earlier use of antibiotics, cytokines, and ICU admission. I look forward to further research in this area that facilitates identification and targeted treatment of patients with hematologic malignancies at risk for septic shock.”
Disclosure: For full disclosures of the study authors, visit jnccn.org.
