Sepsis and shock septic among patients with hematological malignancies: Factors associated with mortality

Abstract

Background: Sepsis is the leading cause of death in patients with onco-hematological diseases with mortality rate of up to 60%. Despite the high relevance of sepsis, few studies have analyzed its impact on this population. To evaluate the factors associated with 30- and 90-day mortality in onco-hematological patients and sepsis. Methods: This retrospective cohort study was conducted at the Euryclides de Jesus Zerbini Transplant Hospital, a tertiary service for patients with hematological malignancies and bone marrow transplantation in São Paulo, Brazil. We included patients diagnosed with sepsis consecutively between August 2013 and July 2016 and followed-up for 30 and 90 days. Results: Over the 3-year period, 123 patients with sepsis were diagnosed, median age of 59.7 years. The most frequent hematological disease was acute leukemia (31.0%). Sepsis and septic shock occurred in 52.2% and 47.8% of patients, respectively. The mortality rate was 33.9% at 30 days and 49.1% at 90 days. The main infectious diseases were pneumonia (32.7%) and bloodstream infections (30.1%). In multivariate analysis, the factors related to 30-day mortality were Sequential Organ Failure Assessment (SOFA) score (p=0.001), severe neutropenia (p=0.049), thrombocytopenia (p=0.045), and increased bilirubin (p=0.038). The associated factors to 90-day mortality were Sequential Organ Failure Assessment score (p=0.001), thrombocytopenia (p=0.45), and increased bilirubin (p=0.066). Infectious agents were identified in 46.9% of cases. Klebsiella pneumoniae was the predominant species and carbapenem-resistant in 61.5% of cases. Conclusions: SOFA score, thrombocytopenia and increased bilirubin were factors associated with mortality in onco-hematological patients and sepsis.