关键词: 重症监护病房, 肿瘤相关脓毒症, 脏器功能衰竭, 病原, 预后

Abstract: Objective To analyze the prognosis of cancer-related sepsis in adult intensive care unit (ICU) to provide the evidence for clinical treatment. Methods The medical records of 1, 325 adult septic patients in ICU, collected from the scientific research data system of Beijing Shijitan Hospital, Capital Medical University between January 2016 and December 2020, were analyzed retrospectively. The patients were divided into the cancer-related sepsis group and the non-cancer-related sepsis group according to whether the patient had tumor diseases. The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, infection site, number and time of mechanical ventilation, time of continuous renal replacement therapy (CRRT), proportion of organ failure, survival rate and length of hospital stay were compared between the two groups. Results Among the 1, 325 adult sepsis patients, 493 cases were cancer-related sepsis and 832 cases were non-cancer-related sepsis. APACHE Ⅱ score of cancer-related sepsis group was higher than that of non-cancer-related sepsis (P=0.001). There were significant differences in infection sites between the two groups when admitted to ICU, mainly manifested as lower proportion of respiratory tract infection in patients with cancer-related sepsis group and higher proportion of infection in digestive tract, urinary tract, blood, central nerve, skin soft tissue and other parts (all P <0.001). The number and time of patients receiving mechanical ventilation and CRRT, the proportion of fungal infection and unidentified pathogens in cancer-related sepsis group were also higher than those in non-cancer-related sepsis group (all P<0.05). The proportion of respiratory failure in cancer-related sepsis group was lower than that in non-cancer-related sepsis group, while the proportion of shock, heart failure, renal insufficiency, liver insufficiency, gastrointestinal dysfunction and coagulation dysfunction was higher than that in non-cancer-related sepsis group(all P<0.05). The 28 days survival rate and ICU overall survival rate of patients with non-cancer-related sepsis were significantly better than those with cancer-related sepsis (all P<0.05). Conclusions Patients with cancer-related sepsis are more severely ill when admitted to ICU, and the organ dysfunction, life support methods and pathogens are all different from those of patients with non-cancer-related sepsis, and the survival rate is also lower. Therefore, it is necessary to study the evaluation, diagnosis and treatment strategies of cancer-related sepsis.

Key words: Intensive care unit, Cancer-related sepsis, Organ failure, Pathogeny, Prognosis