Sepsis mortality among patients with haematological malignancy admitted to intensive care 2000-2022: a binational cohort study.

Autor: MacPhail A; 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., Dendle C; 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., Slavin M; 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., Weinkove R; 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., Bailey M; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia., Pilcher D; 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., McQuilten Z; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia. Zoe.mcquilten@monash.edu.; Department of Haematology, Monash Health, 246 Clayton Road, Clayton, VIC, 3168, Australia. Zoe.mcquilten@monash.edu.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 May 06; Vol. 28 (1), pp. 148. Date of Electronic Publication: 2024 May 06.
DOI: 10.1186/s13054-024-04932-0
Abstrakt: 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 × 10 9  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.
(© 2024. The Author(s).)
Databáze: MEDLINE
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