• Virginie Lemiale, Stéphanie Pons, Adrien Mirouse, Jean-Jacques Tudesq, Yannick Hourmant, Djamel Mokart, Frédéric Pène, Achille Kouatchet, Julien Mayaux, Martine Nyunga, Fabrice Bruneel, Anne-Pascale Meert, Edith Borcoman, Magali Bisbal, Matthieu Legrand, Dominique Benoit, Elie Azoulay, Michaël Darmon, and Lara Zafrani.
• Medical ICU, Saint-Louis Teaching Hospital, Paris, France.
• Crit. Care Med. 2020 Jun 1; 48 (6): 822-829.

ObjectivesCancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades.Data SourceSeven European ICUs.Study SelectionA hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors for day 30 mortality.Data ExtractionData from cancer patients admitted to ICUs for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique database (1994-2015).Data SynthesisOverall, 2,062 patients (62% men, median [interquartile range] age 59 yr [48-67 yr]) were included in the study. Underlying malignancies were solid tumors (n = 362; 17.6%) or hematologic malignancies (n = 1,700; 82.4%), including acute leukemia (n = 591; 28.7%), non-Hodgkin lymphoma (n = 461; 22.3%), and myeloma (n = 244; 11.8%). Two-hundred fifty patients (12%) underwent allogeneic hematopoietic stem cell transplantation and 640 (31.0%) were neutropenic at ICU admission. Day 30 mortality was 39.9% (823 deaths). The year of ICU admission was associated with significant decrease in day 30 mortality over time (odds ratio, 0.96; 95% CI, 0.93-0.98; p = 0.001). Mechanical ventilation (odds ratio, 3.25; 95% CI, 2.52-4.19; p < 0.01) and vasopressors use (odds ratio, 1.42; 95% CI, 1.10-1.83; p < 0.01) were independently associated with day 30 mortality, whereas underlying malignancy, allogeneic hematopoietic stem cell transplantation, and neutropenia were not.ConclusionsSurvival in critically ill oncology and hematology patients with sepsis improved significantly over time. As outcomes improve, clinicians should consider updating admission policies and goals of care in this population.

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