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Time Course of Septic Shock in Immunocompromised and Nonimmunocompromised Patients

Jamme, Matthieu MD1; Daviaud, Fabrice MD1,2; Charpentier, Julien MD1; Marin, Nathalie PharmD1; Thy, Michaël MD1; Hourmant, Yannick MD1; Mira, Jean-Paul MD, PhD1,2,3; Pène, Frédéric MD, PhD1,2,3

doi: 10.1097/CCM.0000000000002722
Clinical Investigations

Objectives: To address the impact of underlying immune conditions on the course of septic shock with respect to both mortality and the development of acute infectious and noninfectious complications.

Design: An 8-year (2008–2015) monocenter retrospective study.

Setting: A medical ICU in a tertiary care center.

Patients: Patients diagnosed for septic shock within the first 48 hours of ICU admission were included. Patients were classified in four subgroups with respect to their immune status: nonimmunocompromised and immunocompromised distributed into hematologic or solid malignancies and nonmalignant immunosuppression. Outcomes were in-hospital death and the development of ischemic and hemorrhagic complications and ICU-acquired infections. The determinants of death and complications were addressed by multivariate competing risk analysis.

Interventions: None.

Measurements and Main Results: Eight hundred one patients were included. Among them, 305 (38%) were immunocompromised, distributed into solid tumors (122), hematologic malignancies (106), and nonmalignant immunosuppression (77). The overall 3-day, in-ICU, and in-hospital mortality rates were 14.1%, 37.3%, and 41.3%, respectively. Patients with solid tumors displayed increased in-hospital mortality (cause-specific hazard, 2.20 [95% CI, 1.64–2.96]; p < 0.001). ICU-acquired infections occurred in 211 of the 3-day survivors (33%). In addition, 95 (11.8%) and 70 (8.7%) patients exhibited severe ischemic or hemorrhagic complications during the ICU stay. There was no association between the immune status and the occurrence of ICU-acquired infections. Nonmalignant immunosuppression and hematologic malignancies were independently associated with increased risks of severe ischemic events (cause-specific hazard, 2.12 [1.14–3.96]; p = 0.02) and hemorrhage (cause-specific hazard, 3.17 [1.41–7.13]; p = 0.005), respectively.

Conclusions: The underlying immune status impacts on the course of septic shock and on the susceptibility to ICU-acquired complications. This emphasizes the complexity of sepsis syndromes in relation with comorbid conditions and raises the question of the relevant endpoints in clinical studies.

1Service de réanimation médicale, Hôpital Cochin, Hôpitaux Universitaires Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France.

2Université Paris Descartes, Paris, France.

3Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.

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Presented, in part, at the congress “Réanimation 2017,” Paris, France, January 11–13, 2017.

Dr. Mira disclosed funding from Merck Sharp & Dohme (MSD) (fees for lecture), and he is a member of the scientific committee for Laboratoire français du Fractionnement et des Biotechnologies and a member of the scientific board for MSD. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Dr. Pène is the guarantor of the content of the article, including the data and analysis. Drs. Jamme and Pène designed the study, collected the data, performed the analysis and drafted the article. Drs. Daviaud, Charpentier, Marin, Thy, Hourmant, and Mira collected the data, contributed to data interpretation and analysis, and revised the article for important intellectual content.

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Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.