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Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon.

ABSTRACT: Most sepsis studies have looked at the general population. The aim of this study is to report on the characteristics, treatment and hospital mortality of patients with cancer diagnosed with sepsis or septic shock.A single-centre retrospective study at a tertiary care centre looking at patients with cancer who presented to our tertiary hospital with sepsis, septic shock or bacteraemia between 2010 and 2015.176 patients with cancer were compared with 176 cancer-free controls.The primary outcome of this study was the in hospital mortality in both cohorts. Secondary outcomes included patient demographics, emergency department (ED) vital signs and parameters of resuscitation along with laboratory work.A total of 352 patients were analysed. The mean age at presentation for the cancer group was 65.39±15.04?years, whereas the mean age for the control group was 74.68±14.04?years (p<0.001). In the cancer cohort the respiratory system was the most common site of infection (37.5%) followed by the urinary system (26.7%), while in the cancer-free arm, the urinary system was the most common site of infection (40.9%). intravenous fluid replacement for the first 24?hours was higher in the cancer cohort. ED, intensive care unit and general practice unit length of stay were comparable in both the groups. 95 (54%) patients with cancer died compared with 75 (42.6%) in the cancer-free group. The 28-day hospital mortality in the cancer cohort was 87 (49.4%) vs 46 (26.1%) in the cancer-free cohort (p=0.009). Patients with cancer had a 2.320 (CI 95% 1.225 to 4.395, p=0.010) odds of dying compared with patients without cancer in the setting of sepsis.This is the first study looking at an in-depth analysis of sepsis in the specific oncology population. Despite aggressive care, patients with cancer have higher hospital mortality than their cancer-free counterparts while adjusting for all other variables.

SUBMITTER: Abou Dagher G

PROVIDER: S-EPMC5353271 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon.

Abou Dagher Gilbert G El Khuri Christopher C Chehadeh Ahel Al-Hajj AA Chami Ali A Bachir Rana R Zebian Dina D Bou Chebl Ralphe R

BMJ open 20170313 3

<h4>Objective</h4>Most sepsis studies have looked at the general population. The aim of this study is to report on the characteristics, treatment and hospital mortality of patients with cancer diagnosed with sepsis or septic shock.<h4>Setting</h4>A single-centre retrospective study at a tertiary care centre looking at patients with cancer who presented to our tertiary hospital with sepsis, septic shock or bacteraemia between 2010 and 2015.<h4>Participants</h4>176 patients with cancer were compar ...[more]

PMID: 28289047

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Project description:Mucormycosis (MCM) is a serious invasive fungal disease (IFD) that is associated with high mortality, particularly in immunocompromised patients. A global surge in MCM cases was reported with the COVID-19 pandemic. We analyzed all recorded cases of MCM at the American University of Beirut Medical Center (AUBMC), a tertiary care center in Lebanon, over 14 years. We aimed to identify the incidence, seasonal variation, clinical characteristics of the patients, and predictors of mortality. We conducted a retrospective chart review between 1 January 2008 and 1 January 2023. All patients with proven or probable MCM were included in the study. Proven or probable MCM was defined by positive histopathology and/or positive cultures. A total of 43 patients were identified as having MCM. Their median age was 53 years, and the majority were males (58.1%). Most of the cases were diagnosed in the autumn season. In total, 67.4% of the patients had hematological malignancies (HMs), and 34.9% had uncontrolled diabetes mellitus (DM). The most common site of involvement was rhino-orbital-cerebral MCM (ROCM) (74%). The annual cases of MCM per 100,000 patient days increased markedly during the years of the COVID-19 pandemic (from 0 to 4.4 cases/100,000 patient days to 7.5 cases/100,000 during 2020 and 2021). Liposomal amphotericin (Ampho) B was used as a first-line agent in most of the patients (86%). The median duration of total in-hospital antifungal therapy was 21 days and 51.2% of the patients received step-down therapy with azoles. Surgical debridement and isolated ROCM were significantly associated with survival (p-value: 0.02 and <0.001, respectively). All-cause mortality was 46.7%, with chronic renal disease being significantly associated with mortality (p-value < 0.05). The incidence of MCM has been increasing at our institution, particularly since the COVID-19 pandemic. Early diagnosis, treatment, and surgical debridement improve patient outcomes and overall survival.

Project description:BackgroundEGDT (Early Goal Directed Therapy) or some portion of EGDT has been shown to decrease mortality secondary to sepsis and septic shock.ObjectiveOur study aims to assess the effect of adopting this approach in the emergency department on in-hospital mortality secondary to sepsis/septic shock in Lebanon.HypothesisImplementation of the EGDT protocol of sepsis in ED will decrease in-hospital mortality.MethodsOur retrospective study included 290 adult patients presenting to the ED of a tertiary center in Lebanon with severe sepsis and/or septic shock. 145 patients between years 2013 and 2014 who received protocol care were compared to 145 patients treated by standard care between 2010 and 2012. Data from the EHR were retrieved about patients' demographics, medical comorbidities, and periresuscitation parameters. A multivariate analysis using logistic regression for the outcome in-hospital mortality after adjusting for protocol use and other confounders was done and AOR was obtained for the protocol use. 28-day mortality, ED, and hospital length of stay were compared between the two groups.ResultsThe most common infection site in the protocol arm was the lower respiratory tract (42.1%), and controls suffered more from UTIs (33.8%). Patients on protocol care had lower in-hospital mortality than that receiving usual care, 31.7% versus 47.6% (p=0.006) with an AOR of 0.429 (p =0.018). Protocol patients received more fluids at 6 and 24 hours (3.8 ± 1.7 L and 6.1 ± 2.1 L) compared to the control group (2.7 ± 2.0 L and 4.9 ± 2.8 L p=<0.001). Time to and duration of vasopressor use, choice of appropriate antibiotics, and length of ED stay were not significantly different between the two groups.ConclusionEGDT- (Early Goal Directed Therapy-) based sepsis protocol implementation in EDs decreases in-hospital mortality in developing countries. Adopting this approach in facilities with limited resources, ICU capabilities, and prehospital systems may have a pronounced benefit.

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Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon.

Publications

Are patients with cancer with sepsis and bacteraemia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care centre in Lebanon.

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