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Cancer Patients Are at High Risk of Mortality if Presenting with Sepsis at an Emergency Department

  • Prachanukool, Thidathit (Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University) ;
  • Tangkulpanich, Panvilai (Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University) ;
  • Paosaree, Possawee (Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University) ;
  • Sawanyawisuth, Kittisak (Department of Medicine, Faculty of Medicine, Khon Kaen University) ;
  • Sitthichanbuncha, Yuwares (Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University)
  • Published : 2016.07.01

Abstract

Background: Sepsis is an emergency condition with high mortality and morbidity rate. There are limited data on the association of cancer as a risk factor for mortality in sepsis patients in the emergency department (ED). Materials and Methods: This retrospective study was conducted at the ED, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand. The study period was between January 1st and December $31^{st}$, 2014. The inclusion criteria were as follows: adult patients over 15 years of age who presented at the ED with suspicion of sepsis, received treatment at the ED, and whose blood culture was found to be positive. Clinical data were recorded from medical records including the Mortality in Emergency Department Sepsis score (MEDS score). The primary outcome of this study was mortality at one month. Multivariate logistic regression analysis was used to identify independent factors associated with death. Results: During the study period, there were 775 eligible patients. The two most common pathogens identified from blood cultures were Staphylococcus aureus (193 patients; 24.9%) and Escherichia coli (158 patients; 20.4%). At one month after presenting at the ED, 110 patients (14.2%) had died. There were four significant factors for death, having cancer, being on an endotracheal tube, initial diagnosis of bacteremia, and high MED scores. Having cancer had an adjusted OR of 2.12 (95% CI of 1.29, 3.47). Conclusions: Cancer patients have double the risk of mortality if presenting with sepsis at the ED.

Keywords

Sepsis;cancer;death;predictors;emergency department

Acknowledgement

Supported by : Thailand Research Fund (TRF), Khon Kaen University

References

  1. Angkasekwinai N, Rattanaumpawan P, Thamlikitkul V (2009). Epidemiology of sepsis in Siriraj Hospital 2007. J Med Assoc Thai, 92, 68-78.
  2. Angus DC, Linde-Zwirble WT, Lidicker J, et al (2001). Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med, 29, 1303-10. https://doi.org/10.1097/00003246-200107000-00002
  3. Dellinger RP, Levy MM, Rhodes A, et al (2013). Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med, 39, 165-228. https://doi.org/10.1007/s00134-012-2769-8
  4. Drumheller BC, Agarwal A, Mikkelsen ME, et al (2016). Risk factors for mortality despite early protocolized resuscitation for severe sepsis and septic shock in the emergency department. J Crit Care, 31, 13-20. https://doi.org/10.1016/j.jcrc.2015.10.015
  5. Jemal A, Center MM, DeSantis C, Ward EM (2010). Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev, 19, 1893-907. https://doi.org/10.1158/1055-9965.EPI-10-0437
  6. Khwannimit B, Bhurayanontachai R (2009). The epidemiology of, and risk factors for, mortality from severe sepsis and septic shock in a tertiary-care university hospital setting. Epidemiol Infect, 137, 1333-41. https://doi.org/10.1017/S0950268809002027
  7. Lakshmikanth CL, Jacob SP, Chaithra VH, de Castro-Faria-Neto HC, Marathe GK (2016). Sepsis: in search of cure. Inflamm Res, [Epub ahead of print].
  8. Martin GS, Mannino DM, Eaton S, Moss M (2003). The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med, 348, 1546-54. https://doi.org/10.1056/NEJMoa022139
  9. Putra BE, Tiah L (2013). The mortality in Emergency Department Sepsis Score as a predictor of 1-month mortality among adult patients with sepsis: weighing the evidence. ISRN Emergency Medicine, 896802.
  10. Shapiro NI, Wolfe RE, Moore RB, et al (2003). Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med, 31, 670-5. https://doi.org/10.1097/01.CCM.0000054867.01688.D1
  11. Zhou J, Qian C, Zhao M, et al (2014). Epidemiology and outcome of severe sepsis and septic shock in intensive care units in mainland China. PLoS One, 9, 107181. https://doi.org/10.1371/journal.pone.0107181