Câncer e sepse: inter-relação, prognóstico e mortalidade na unidade de terapia intensiva

Abstract

Recognized as major contributors to increased in-hospital mortality, cases of sepsis and septic shock remain a significant global public health concern. National and international data indicate high lethality rates among patients, particularly those with cancer. Intrinsic and multifactorial elements related to the pathophysiology of cancer and chemotherapy treatment promote the natural immunosuppression of these patients, thereby increasing the risk for developing infections. Epidemiological reports in Brazil point to a national sepsis mortality rate of approximately 55%, which underscores the severity of this issue. This study aimed to analyze cases of sepsis and septic shock among cancer patients admitted to the ICU, as well as to interpret the data and clinical manifestations presented by these patients. This was an observational, cross-sectional, quantitative, retrospective-prospective study, with data analysis extracted from the medical records of cancer patients admitted to an intensive care unit who developed sepsis or were hospitalized due to septicemia. Clinical variables were extracted using an instrument developed by the authors. A total of 1,619 medical records were evaluated from March 2020 to June 2025; 900 patients had a confirmed diagnosis of sepsis, and 276 of these were cancer patients. Clinical parameters established in the Sepsis-3 consensus were used, in addition to indicators proposed by the Surviving Sepsis Campaign. Of the total sample, most patients were male (59.4%), and the majority of the population with cancer, sepsis, and septic shock was concentrated in the 51 to 80 age group. Regarding race/ethnicity, the population was predominantly white (n=263). The most prevalent occupation was agriculture (n = 67; 24.3%). Regarding clinical findings, 875 episodes of organ dysfunction were documented in the patients. In the set of comorbidities evaluated, the most frequent were systemic arterial hypertension (n = 134; 19.9%) and diabetes mellitus (n = 59; 8.8%). In terms of the infectious focus, 355 episodes were identified, with the pulmonary focus being the most prevalent (n = 184; 51.8%). In the tracheal aspirate, the most frequent pathogens were Klebsiella pneumoniae (n = 40; 32.3%), Candida spp., and other fungi (n = 24; 19.4%). Most hospitalized patients were not classified for sepsis using any hospital protocol or other validated instrument recommended by guidelines (n = 264; 95.3%). Regarding prognosis, 134 patients with sepsis (13.47%) and 133 with septic shock (13.37%) progressed to death, while 38 patients with sepsis (0.8%) and 1 with septic shock (0.10%) were discharged from the hospital. Considering the total population of 995 patients (of whom 719 did not have sepsis or cancer), 499 (50.15%) died and 220 (22.11%) were discharged. Thus, the overall mortality of patients with cancer and sepsis/septic shock was 26.8%. In conclusion, sepsis and septic shock remain leading factors of mortality in the hospital setting. Actions by the nursing team, such as early identification, the use of established protocols, and the application of international guidelines, are essential for improving the patient's diagnosis. Such action assists in the management, treatment, and potential increase in the survival of these patients. Furthermore, fostering a culture of continuing education is critical to expand the knowledge of teams in life-threatening situations.