Journal Article

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

Slavin, Monica, Weinkove, Robert, McQuilten, Zoe, Dendle, Claire, Bailey, Michael, MacPhail, Aleece, Pilcher, David

2024

Overview

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. Graphical abstract Key points Among patients with haematological malignancy and sepsis admitted to intensive care, mortality has fallen by over 50% in the last two decades. Improvements are independent of organ failure, neutropenia, and age; however, mortality remains higher than for patients with no malignancy.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adult / Aged / Aged, 80 and over / Analysis / Artificial respiration / Australia / Australia - epidemiology / Blood & organ donations / Blood cancer / Blood cell count / Cancer patients / Cancer therapies / Care and treatment / Cohort analysis / Cohort Studies / Comorbidity / Complications and side effects / Critical Care Medicine / Demographics / Diagnosis / Emergency Medicine / Female / Health aspects / Health care expenditures / Hematologic Neoplasms - mortality / Hematology / Hospital Mortality - trends / Humans / Infection / Infections / Intensive / Intensive care / Intensive Care Units - organization & administration / Intensive Care Units - statistics & numerical data / Length of stay / Leukemia / Leukopenia / Logistic Models / Lymphoma / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Middle Aged / Mortality / Multiple myeloma / New Zealand / New Zealand - epidemiology / Palliative care / Patient admissions / Patient outcomes / Physiology / Regression analysis / Retrospective Studies / Risk Factors / Sepsis / Sepsis - mortality / Teaching hospitals / Variables / Ventilators