Neutropenic Sepsis in the Intensive Care Unit: Differences in Clinical Profile and Outcomes According to the Cause of Neutropenia
- Author(s)
- MacPhail, A; Dendle, C; Slavin, M; Weinkove, R; Bailey, M; Pilcher, D; McQuilten, Z;
- Details
- Publication Year 2024-06,Volume 11,Issue #6,Page ofae289
- Journal Title
- Open Forum Infectious Diseases
- Publication Type
- Research article
- Abstract
- 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.
- Publisher
- Oxford University Press
- Keywords
- cancer; immunocompromised hosts; neutropenia; sepsis; supportive care
- Department(s)
- Infectious Diseases
- Publisher's Version
- https://doi.org/10.1093/ofid/ofae289
- Open Access at Publisher's Site
https://doi.org/10.1093/ofid/ofae289- Terms of Use/Rights Notice
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Creation Date: 2024-08-06 08:21:52
Last Modified: 2024-08-06 08:24:57