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Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate

The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in se...

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Autores principales: López, René, Pérez-Araos, Rodrigo, Baus, Fernanda, Moscoso, Camila, Salazar, Álvaro, Graf, Jerónimo, Montes, José Miguel, Samtani, Suraj
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107210/
https://www.ncbi.nlm.nih.gov/pubmed/33981712
http://dx.doi.org/10.3389/fmed.2021.603275
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author López, René
Pérez-Araos, Rodrigo
Baus, Fernanda
Moscoso, Camila
Salazar, Álvaro
Graf, Jerónimo
Montes, José Miguel
Samtani, Suraj
author_facet López, René
Pérez-Araos, Rodrigo
Baus, Fernanda
Moscoso, Camila
Salazar, Álvaro
Graf, Jerónimo
Montes, José Miguel
Samtani, Suraj
author_sort López, René
collection PubMed
description The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, p = 0.013) and associated with lower survival (65.4% vs. 85.7%, p = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998–24.731], p = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402–5.160], p = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification.
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spelling pubmed-81072102021-05-11 Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate López, René Pérez-Araos, Rodrigo Baus, Fernanda Moscoso, Camila Salazar, Álvaro Graf, Jerónimo Montes, José Miguel Samtani, Suraj Front Med (Lausanne) Medicine The number of oncological patients (OP) admitted to intensive care units (ICU) for sepsis/septic shock has dramatically increased in recent years. The definition of septic shock has been modified, adding hyperlactatemia as a severity biomarker for mortality. However, it remains poorly reported in septic OP. We performed a retrospective analysis from a prospective database of sepsis/septic shock patients admitted to our ICU between September 2017 and September 2019 and followed until day 90. We identified 251 patients and 31.9% had active oncological comorbidity, mainly solid tumor (81.3%). Septic shock criteria were met for 112 (44.6%). Hyperlactatemia was observed in 136 (54.2%) patients and this was associated with a lower survival rate. Overall 90-day mortality was 15.1%. In OP vs. non-OP, hyperlactatemia was more frequent (65% vs. 49.1%, p = 0.013) and associated with lower survival (65.4% vs. 85.7%, p = 0.046). In OP, poor performance status was also associated with lower survival (HR 7.029 [1.998–24.731], p = 0.002) In an adjusted analysis, cancer was associated with lower 90-day survival (HR 2.690 [1.402–5.160], p = 0.003). In conclusion, septic OP remains a high mortality risk group in whom lactate levels and performance status could help with better risk stratification. Frontiers Media S.A. 2021-04-26 /pmc/articles/PMC8107210/ /pubmed/33981712 http://dx.doi.org/10.3389/fmed.2021.603275 Text en Copyright © 2021 López, Pérez-Araos, Baus, Moscoso, Salazar, Graf, Montes and Samtani. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
López, René
Pérez-Araos, Rodrigo
Baus, Fernanda
Moscoso, Camila
Salazar, Álvaro
Graf, Jerónimo
Montes, José Miguel
Samtani, Suraj
Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate
title Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate
title_full Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate
title_fullStr Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate
title_full_unstemmed Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate
title_short Outcomes of Sepsis and Septic Shock in Cancer Patients: Focus on Lactate
title_sort outcomes of sepsis and septic shock in cancer patients: focus on lactate
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8107210/
https://www.ncbi.nlm.nih.gov/pubmed/33981712
http://dx.doi.org/10.3389/fmed.2021.603275
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