Neutropenic Sepsis in the Intensive Care Unit: Differences in Clinical Profile and Outcomes According to the Cause of Neutropenia.

Autor: MacPhail A; 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., Dendle C; 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., Slavin M; 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., Weinkove R; 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., Bailey M; School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia., Pilcher D; 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., McQuilten Z; 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.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2024 May 19; Vol. 11 (6), pp. ofae289. Date of Electronic Publication: 2024 May 19 (Print Publication: 2024).
DOI: 10.1093/ofid/ofae289
Abstrakt: 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 × 10 9 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.
Competing Interests: Potential conflicts of interest. R. W. declares research grant funding (Janssen, paid to institution); speaker fees (Janssen, Abbvie); advisory board participation (AbbVie, Beigene, Janssen); data safety monitoring boards (C-SMART DSMB NCT04534725, RATIONALISE steering committee ACTRN12622000359730). A. M. is supported by an Australian National Health and Medical Research Council (NHMRC) Postgraduate scholarship (GNT2022415) and Z. M. is supported by an NHMRC Emerging Leader Fellowship (GNT1194811). The authors have no competing interests to declare. The authors: No reported conflicts of interest.
(© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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