Elevation in serum lactate at the time of febrile neutropenia (FN) in hemodynamically-stable patients with hematologic malignancies (HM) is associated with the development of septic shock within 48 hours

Anthony R. Mato, Selina M. Luger, Daniel F. Heitjan, Mark E. Mikkelsen, Erin Olson, Chaitra Ujjani, Samantha Jacobs, Andrea N. Miltiades, Payal Shah, Stephen J. Schuster, Martin Carroll, Ann Duskin Chauffe, Barry D. Fuchs

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Hospitalized patients who develop febrile neutropenia (FN) are treated empirically with antibiotics due to a high risk of developing septic shock. Currently, there is no method to predict which patients are at greatest risk. This study was designed to determine whether serum lactate, measured at the time of FN, is associated with the development of septic shock in hospitalized hematologic malignancy (HM) patients. Results: Of the 547 patients enrolled, 46 (8.4%; 95% CI 6.2-10.9) developed septic shock. Baseline characteristics were similar between the groups. In univariate analysis, tachypnea (OR 5.9; 95% CI: 2.0-16.9, p = 0.001) and lactate (OR 18.4; 95% CI: 4.1-81.6, p < 0.001) were significantly associated with the development of septic shock. In multivariate analysis, lactate and tachypnea remained independently associated with the development of septic shock. By ROC analysis, lactate provided incremental prognostic value compared to vital signs alone. Methods: Vital signs and lactate were measured during episodes of FN. The primary endpoint was the development of septic shock. Using a prospective, nested, case-control design, controls were matched on length of stay at the time of septic shock to achieve 80% power to detect an OR of ≥2.5. Using logistic regression, we evaluated the association of vital signs and lactate with the subsequent development of septic shock. Conclusions: in FN patients, measurement of lactate during FN adds significant prognostic information about the risk of developing septic shock. Routine measurement of lactate may help identify patients who may benefit from increased monitoring and early intervention strategies.

Original languageEnglish (US)
Pages (from-to)585-589
Number of pages5
JournalCancer Biology and Therapy
Volume9
Issue number8
DOIs
StatePublished - Apr 15 2010

Fingerprint

Febrile Neutropenia
Hematologic Neoplasms
Septic Shock
Lactic Acid
Serum
Vital Signs
Tachypnea
ROC Curve
Length of Stay
Multivariate Analysis
Logistic Models
Anti-Bacterial Agents

Keywords

  • Febrile neutropenia
  • Hematologic malignancies
  • Lactate
  • Lactic acidosis
  • Sepsis
  • Septic shock
  • Severe sepsis
  • Systemic inflammatory response syndrome

ASJC Scopus subject areas

  • Molecular Medicine
  • Oncology
  • Pharmacology
  • Cancer Research

Cite this

Elevation in serum lactate at the time of febrile neutropenia (FN) in hemodynamically-stable patients with hematologic malignancies (HM) is associated with the development of septic shock within 48 hours. / Mato, Anthony R.; Luger, Selina M.; Heitjan, Daniel F.; Mikkelsen, Mark E.; Olson, Erin; Ujjani, Chaitra; Jacobs, Samantha; Miltiades, Andrea N.; Shah, Payal; Schuster, Stephen J.; Carroll, Martin; Chauffe, Ann Duskin; Fuchs, Barry D.

In: Cancer Biology and Therapy, Vol. 9, No. 8, 15.04.2010, p. 585-589.

Research output: Contribution to journalArticle

Mato, Anthony R. ; Luger, Selina M. ; Heitjan, Daniel F. ; Mikkelsen, Mark E. ; Olson, Erin ; Ujjani, Chaitra ; Jacobs, Samantha ; Miltiades, Andrea N. ; Shah, Payal ; Schuster, Stephen J. ; Carroll, Martin ; Chauffe, Ann Duskin ; Fuchs, Barry D. / Elevation in serum lactate at the time of febrile neutropenia (FN) in hemodynamically-stable patients with hematologic malignancies (HM) is associated with the development of septic shock within 48 hours. In: Cancer Biology and Therapy. 2010 ; Vol. 9, No. 8. pp. 585-589.
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abstract = "Background: Hospitalized patients who develop febrile neutropenia (FN) are treated empirically with antibiotics due to a high risk of developing septic shock. Currently, there is no method to predict which patients are at greatest risk. This study was designed to determine whether serum lactate, measured at the time of FN, is associated with the development of septic shock in hospitalized hematologic malignancy (HM) patients. Results: Of the 547 patients enrolled, 46 (8.4{\%}; 95{\%} CI 6.2-10.9) developed septic shock. Baseline characteristics were similar between the groups. In univariate analysis, tachypnea (OR 5.9; 95{\%} CI: 2.0-16.9, p = 0.001) and lactate (OR 18.4; 95{\%} CI: 4.1-81.6, p < 0.001) were significantly associated with the development of septic shock. In multivariate analysis, lactate and tachypnea remained independently associated with the development of septic shock. By ROC analysis, lactate provided incremental prognostic value compared to vital signs alone. Methods: Vital signs and lactate were measured during episodes of FN. The primary endpoint was the development of septic shock. Using a prospective, nested, case-control design, controls were matched on length of stay at the time of septic shock to achieve 80{\%} power to detect an OR of ≥2.5. Using logistic regression, we evaluated the association of vital signs and lactate with the subsequent development of septic shock. Conclusions: in FN patients, measurement of lactate during FN adds significant prognostic information about the risk of developing septic shock. Routine measurement of lactate may help identify patients who may benefit from increased monitoring and early intervention strategies.",
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T1 - Elevation in serum lactate at the time of febrile neutropenia (FN) in hemodynamically-stable patients with hematologic malignancies (HM) is associated with the development of septic shock within 48 hours

AU - Mato, Anthony R.

AU - Luger, Selina M.

AU - Heitjan, Daniel F.

AU - Mikkelsen, Mark E.

AU - Olson, Erin

AU - Ujjani, Chaitra

AU - Jacobs, Samantha

AU - Miltiades, Andrea N.

AU - Shah, Payal

AU - Schuster, Stephen J.

AU - Carroll, Martin

AU - Chauffe, Ann Duskin

AU - Fuchs, Barry D.

PY - 2010/4/15

Y1 - 2010/4/15

N2 - Background: Hospitalized patients who develop febrile neutropenia (FN) are treated empirically with antibiotics due to a high risk of developing septic shock. Currently, there is no method to predict which patients are at greatest risk. This study was designed to determine whether serum lactate, measured at the time of FN, is associated with the development of septic shock in hospitalized hematologic malignancy (HM) patients. Results: Of the 547 patients enrolled, 46 (8.4%; 95% CI 6.2-10.9) developed septic shock. Baseline characteristics were similar between the groups. In univariate analysis, tachypnea (OR 5.9; 95% CI: 2.0-16.9, p = 0.001) and lactate (OR 18.4; 95% CI: 4.1-81.6, p < 0.001) were significantly associated with the development of septic shock. In multivariate analysis, lactate and tachypnea remained independently associated with the development of septic shock. By ROC analysis, lactate provided incremental prognostic value compared to vital signs alone. Methods: Vital signs and lactate were measured during episodes of FN. The primary endpoint was the development of septic shock. Using a prospective, nested, case-control design, controls were matched on length of stay at the time of septic shock to achieve 80% power to detect an OR of ≥2.5. Using logistic regression, we evaluated the association of vital signs and lactate with the subsequent development of septic shock. Conclusions: in FN patients, measurement of lactate during FN adds significant prognostic information about the risk of developing septic shock. Routine measurement of lactate may help identify patients who may benefit from increased monitoring and early intervention strategies.

AB - Background: Hospitalized patients who develop febrile neutropenia (FN) are treated empirically with antibiotics due to a high risk of developing septic shock. Currently, there is no method to predict which patients are at greatest risk. This study was designed to determine whether serum lactate, measured at the time of FN, is associated with the development of septic shock in hospitalized hematologic malignancy (HM) patients. Results: Of the 547 patients enrolled, 46 (8.4%; 95% CI 6.2-10.9) developed septic shock. Baseline characteristics were similar between the groups. In univariate analysis, tachypnea (OR 5.9; 95% CI: 2.0-16.9, p = 0.001) and lactate (OR 18.4; 95% CI: 4.1-81.6, p < 0.001) were significantly associated with the development of septic shock. In multivariate analysis, lactate and tachypnea remained independently associated with the development of septic shock. By ROC analysis, lactate provided incremental prognostic value compared to vital signs alone. Methods: Vital signs and lactate were measured during episodes of FN. The primary endpoint was the development of septic shock. Using a prospective, nested, case-control design, controls were matched on length of stay at the time of septic shock to achieve 80% power to detect an OR of ≥2.5. Using logistic regression, we evaluated the association of vital signs and lactate with the subsequent development of septic shock. Conclusions: in FN patients, measurement of lactate during FN adds significant prognostic information about the risk of developing septic shock. Routine measurement of lactate may help identify patients who may benefit from increased monitoring and early intervention strategies.

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KW - Hematologic malignancies

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KW - Lactic acidosis

KW - Sepsis

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KW - Severe sepsis

KW - Systemic inflammatory response syndrome

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