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

MacPhail, A; Dendle, C; Slavin, M; Weinkove, R; Bailey, M; Pilcher, D; McQuilten, Z

Author(s): MacPhail, A; Dendle, C; Slavin, M; Weinkove, R; Bailey, M; Pilcher, D; McQuilten, Z;
Details: Publication Year 2024-05-06,Volume 28,Issue #1,Page 148
Journal Title: Critical Care
Publication Type: Research article
Abstract: 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.
Publisher: BioMed Central
Keywords: Humans; *Sepsis/mortality; *Hematologic Neoplasms/mortality; Male; Middle Aged; Female; Aged; Retrospective Studies; *Intensive Care Units/organization & administration/statistics & numerical data; New Zealand/epidemiology; Cohort Studies; *Hospital Mortality/trends; Australia/epidemiology; Adult; Logistic Models; Risk Factors; Aged, 80 and over
Department(s): Infectious Diseases
Publisher's Version: https://doi.org/10.1186/s13054-024-04932-0
Open Access at Publisher's Site: https://doi.org/10.1186/s13054-024-04932-0
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-07-16 07:55:44

Last Modified: 2024-07-16 07:59:12