PCT and IL-6 appear to be early markers of subsequent postoperative sepsis in patients undergoing major surgery for cancer. These findings could allow identification of postoperative septic complications.

No abstract

Our data suggest that, in ICU, de-escalation of the empirical antimicrobial treatment is frequently applied in neutropenic cancer patients with severe sepsis. No evidence of any prognostic impact of this de-escalation was found.

Early diastolic dysfunction is a strong and independent predictor of mortality in cancer patients presenting with septic shock. It is not associated with exposure to cardiotoxic drugs. Further studies incorporating monitoring of diastolic function and therapeutic interventions improving cardiac relaxation need to be evaluated in cancer patients presenting with septic shock.

Introduction The overall prognosis of critically ill patients with cancer has improved during the past decade. The aim of this study was to identify early prognostic factors of intensive care unit (ICU) mortality in patients with cancer.

Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-015-3994-8) contains supplementary material, which is available to authorized users.Dear Editor, Acute respiratory failure is a dramatic event and remains a major cause of ICU admission in cancer patients [1]. It has been recently shown that highflow oxygen therapy through a nasal cannula in association with noninvasive ventilation (HFNC-NIV) during acute respiratory failure is associated with high mortality in unselected patients with hypoxemic acute respiratory failure (FLORALI study) [2]. We retrospectively analyzed 178 cancer patients admitted to the ICU for severe acute respiratory failure (O 2 delivery [9 L/min). We computed a propensity score to predict HFNC-NIV treatment based on specific characteristics at ICU admission. The primary outcome was all-causes mortality at day 28; secondary outcomes included the number of ventilator-free days at day 28 and long-term mortality. The study was approved by our institutional review board. For the initial population (n = 178), pulmonary infection (any pathogen) was present in 116 patients (65 %). At ICU admission the median SAPS II was 47 (IQR 38-57), SOFA score 6 (4-9), and PaO 2 /FiO 2 ratio 123 (87-158). A total of 150 patients (84 %) were treated with NIV, 84 (47 %) with HFNC, and 94 (53 %) with standard oxygen. Among these patients, 76 (43 %) were treated with HFNC-NIV, 74 (42 %) with standard O 2 -NIV, 8 (5 %) with standard O 2 alone, and 20 (11 %) with HFNC alone. As compared to the others patients, HFNC-NIV patients presented a lower day-28 mortality rate, 37 % (n = 28) vs 52 % (n = 53), p = 0.045; a longer time from ICU admission to intubation 34 h (18-72) vs 16 h (7-45), p = 0.01; and a higher but not significant number of ventilator-free days, 24 (2-28) vs 8 (1-28), p = 0.06.

We have shown that some of the markers that can be easily collected in the preoperative or postoperative visits can be used to screen the patients at high risk for developing severe sepsis after major surgery.

Outcome of patients undergoing allogenic hematopoietic stem cell transplantation (allo-HSCT) has improved. To investigate if this improvement can be transposed to the ICU setting, we conducted a systematic review and meta-analysis to assess short-term mortality of critically ill allo-HSCT patients admitted to the ICU and to identify prognostic factors of mortality. Public-domain electronic databases, including Medline via PubMed and the Cochrane Library were searched. All full-text articles written-English studies published from 2006 to 2016, including allo-HSCT adults transferred to the ICU were included. Eighteen studies were selected, including 2342 patients. Overall estimated ICU mortality was 51.7%. Prognostic factors associated with an increased ICU mortality were mechanical ventilation (OR = 12.2, 95% CI = 6.2-23.7), vasopressors (OR = 6.3, 95% CI = 3.6-11.1), renal replacement therapy (OR = 4.2, 95% CI = 2.8-6.2), ICU admission for acute respiratory failure (OR = 2.2, 95% CI = 1.1-4.4), acute kidney injury (OR = 2.2, 95% CI = 1.3-4), and acute graft-versus-host disease (OR = 1.6, 95% CI = 1.1-2.3). Factors associated with an increased ICU survival were a single-organ failure (OR = 0.2, 95% CI = 0.1-0.4), neurological failure (OR = 0.4, 95% CI = 0.2-0.8), and reduced-intensity conditioning regimens (OR = 0.7, 95% CI = 0.5-0.9). Septic shock, underlying malignancy, disease status, donor, and graft source did not impact prognosis. Outcome has improved, supporting the usefulness of ICU management. Organ failures at ICU admission, organ support requirement, and GVHD are the main prognostic factors.