Prognostic Impact of Neutropenia in Cancer Patients with Septic Shock: A 2009–2017 Nationwide Cohort Study

Abstract

(1) Background: Neutropenia’s prognostic impact on mortality in cancer patients with septic shock remains controversial despite recent advances in cancer and sepsis management. This population-based, case–control study aimed to determine whether neutropenia could be related to an increase in short-term and long-term mortality. (2) Methods: This population-based, case–control study used data from the National Health Insurance Service of Korea. Adult cancer patients who presented to the emergency department with septic shock from 2009 to 2017 were included. The 30-day and 1-year mortality rates were evaluated as short-term and long-term outcomes. Cox proportional hazard regression was performed after adjusting for age, sex, Charlson comorbidity index, and neutropenia. (3) Results: In 43,466 adult cancer patients with septic shock, the 30-day and 1-year mortality rates were 52.1% and 81.3%, respectively. In total, 6391 patients had neutropenic septic shock, and the prevalent cancer type was lung cancer, followed by leukemia, non-Hodgkin’s lymphoma, stomach cancer, and colon cancer. Furthermore, 30-day and 1-year mortality was lower in patients with neutropenia than in those without neutropenia. After adjustment for confounders, neutropenia was independently associated with decreased 30-day and 1-year mortality rates. (4) Conclusions: In cancer patients presenting to the emergency department with septic shock, the presence of neutropenia did not increase mortality. This suggests that neutropenia may not be used as a single triage criterion for withholding intensive care in cancer patients presenting to the emergency department with septic shock.

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

“…Leukopenia (leukocytes < 1.00 × 10 9 cells/L) was independently associated with mortality for patients without haematological malignancy, but was not a risk factor among patients with haematological malignancy. Previous studies describing the impact of neutropenia on sepsis mortality have yielded conflicting results, possibly related to heterogeneity of included patients [ 29 ] However, a population based cohort study of 43,466 patients with cancer and septic shock in Korea reported lower mortality in those with neutropenia [ 30 ]. We used leukopenia of < 1.00 × 10 9 cells/L as a surrogate for neutropenia, and observed a significant interaction between the effect of leukopenia and the presence of haematological malignancy.…”

Neutropenic Sepsis in the Intensive Care Unit: Differences in Clinical Profile and Outcomes According to the Cause of Neutropenia

“…These findings add to a growing body of evidence suggesting favorable prognosis in patients with neutropenic hematological malignancy compared to other neutropenic patients with sepsis [ 14 , 15 ]. A large cohort study performed in Korea reported lower mortality among hematology patients with neutropenic compared to nonneutropenic sepsis [ 11 ]. Neutropenia in patients with hematological malignancy is frequently a transient and predictable toxicity of cancer therapy and may be expected to resolve spontaneously or with growth factor administration.…”

Bloodstream infections in neutropenic and non-neutropenic patients with haematological malignancies: epidemiological trends and clinical outcomes in Queensland, Australia over the last 20 years

“…In this context, in cohorts of patients with haematological malignancies and BSI, neutropenia might not be a major determinant of short-term mortality anymore, particularly in critically ills [ 33 , 34 ]. Indeed, BSI during neutropenia might have similar [ 11 , 35 ] or even sometimes better outcomes [ 10 , 20 , 36 ] compared to those in non-neutropenic patients, in particular if neutropenia is of short duration [ 3 ] and in the absence of metastatic localisation of infection, but rather in the context of transient bacteraemia [ 20 , 21 , 32 ]. BSI in neutropenic patients may also have better or comparable outcomes when compared to BSI in highly comorbid non-neutropenic patients [ 10 , 20 , 21 ].…”