CHEST Guidelines-Septic-Shock-in-Patients-With-Solid-Malignancies

Septic-Shock-in-Patients-With-Solid-Malignancies_c

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The document discusses septic shock in patients with solid malignancies, with a specific focus on the study by Cuenca et al. in "CHEST" which evaluated critically ill patients meeting sepsis-3 criteria for septic shock. This patient population, comprising 271 individuals, exhibited alarmingly high mortality rates—67% at 28 days, 75% at 90 days, and nearly 95% within one year. Comparatively, a larger cohort receiving vasopressors but not fitting strict septic shock criteria had significantly lower mortality rates, suggesting that meeting sepsis-3 criteria identifies a particularly severe group.<br /><br />The study highlighted several critical issues: most patients had metastatic disease, poor Eastern Cooperative Oncology Group performance status, and few had recent chemotherapy, suggesting potential frailty and non-candidacy for intensive cancer therapies. Survival was linked to better performance status and absence of metastases, none of which are modifiable during acute illness.<br /><br />Additionally, most patients with septic shock were admitted from hospital wards rather than emergency departments, raising concerns about potential mis-triage and the importance of early sepsis detection among hospitalized cancer patients. The study’s robust methodology included multiple physician reviews of patient data and considerations of care limitations, which enhance the reliability of its findings.<br /><br />Overall, the document emphasizes the need for targeted improvements in sepsis screening and management for cancer patients, consideration of cancer-specific early warning systems, and reevaluation of current sepsis and septic shock definitions for this population. The authors call for further research, particularly concerning patients’ therapy status and sepsis sources, to refine clinical practices better and potentially improve outcomes.

Keywords

septic shock

solid malignancies

Cuenca et al.

sepsis-3 criteria

mortality rates

metastatic disease

performance status

early sepsis detection

cancer patients

sepsis management