Impacto da sepse em pacientes com doenças onco-hematológicos

• Ano de defesa: 2018
• Autor(a) principal: Silva, Luciane Luz e [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Sepse; Neutropenia; Onco-Hematológico; Letalidade; Onco-hematológico
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6479357; https://repositorio.unifesp.br/handle/11600/53153

Introduction: Sepsis remains the leading cause of death in patients with hematological malignancies, reaching a rate of 59.3% in up to 6 months. Despite the relevance, few studies have analyzed the impact of sepsis and septic shock in this population. This study aims to determine the rate of lethality related to sepsis and septic shock in 30 and 90 days in patients with oncohematological diseases, to evaluate the variables related to lethality in sepsis and septic shock in this population, to evaluate the adherence to the package of three hours of treatment for sepsis and its relation to lethality. Methods: a historical cohort study, conducted from August 1, 2013 to July 31, 2016, at the Hospital of Transplants Euryclides de Jesus Zerbini (HTEJZ), administered by the Paulista Association for the Development of Medicine (SPDM), a Social Organization (OSS), which provides assistance to users of the Unified Health System. Patients with oncohematological diseases admitted to the Hematology and BMT units who developed sepsis or septic shock, from the community or during hospitalization were included. Patients were followed up to 90 days after episodes of sepsis or even death. Results: In the threeyear study period, 366 patients were diagnosed with sepsis in the institution. Of these, 113 (31.2%) patients had a diagnosis of oncohematological disease and were included in the study. The mean age of the population was 59.9 and the males were the most prevalent (54.9%). Among the baseline diagnoses, acute leukemia was the most frequent (31%), followed by multiple myeloma (26.5%) and lymphomas (21.2%). Twentyone patients (18.6%) had HSCT, and autologous transplantation was more frequent (85.8%). In the evaluated sample, the proportion of sepsis was 59 (52.2%) and septic shock was 54 (47.8%). The main infectious diagnoses were pneumonia 37 (32.7%), primary infection of the bloodstream 34 (30.1%), without focus 17 (15%) and abdominal 15 (13.3%). The majority of the episodes were of hospital origin 96 (85%). The clinical signs and most frequent symptoms in the presentation of sepsis were tachycardia in 90.3% of the cases (n = 102), fever in 68.1% (n = 77) and tachypnea in 63.7% (n = 72). Among the organ dysfunctions, hypotension was the most frequent dysfunction, occurring in 85% of cases (n = 96), followed by hypoxemia (PaO2 / FiO2) in 46.9% (n = 53), lowering of consciousness level in 29 (N = 32), renal dysfunction in 28.3% (n = 32), hyperlactatemia in 24.8% (n = 28), liver dysfunction 19.5% (n = 22) and coagulopathy in 19, 5% (n = 22). The median SOFA was 7 (410). The lactate collection, two blood samples before the start of the antibiotic, antimicrobial in the first hour, and volume expansion of the cases with hypotension signal were performed in 91.1%, 82.3%, 85.0% and 76.9% of the cases, respectively. The adequacy to all items of the 3hour package was 73.5%. Conclusions: the sepsis lethality rate was 33.9% at 30 days and 49.1% at 90 days. In cases of septic shock, the lethality was 49.1% at 30 days and 59.4% at 90 days; SOFA was a predictor of sepsis mortality in patients with oncohematological diseases, in addition to organic dysfunctions, such as hyperbilirubinemia and thrombocytopenia; overall adhesion to the threehour pack was 73.5% and no relationship was found with lethality in the univariate and multivariate statistical analysis.