Septicemia in hematologic malignancies : statistical analysis of prognostic factors

The prognostic significance of patient characteristics, treatment and clinical evolution of the first septicemic episode in 103 patients with hematologic malignancies was evaluated retrospectively with univariate and multivariate statistical analyses. End-points were infection cure rate and survival at 21 days after sepsis onset. Overall cure rate was 56.3% and survival rate 58.3%. Multivariate analysis showed that cure rate correlated with granulocyte count variation, appropriateness of antimicrobial therapy and circulating neutrophil count at the onset of infection; survival correlated with antimicrobial therapy, underlying disease diagnosis, granulocyte count variation, patient performance status, shock, infection nosocomiality, and concomitant steroid therapy. These results confirm thath the fatality rate of sepsis in hematologic malignancies could be reduced by appropriate empiric antimicrobial treatment based on constant microbiologic surveillance and by early selection for intensive care of patients at high risk due to underlying disease gravity, performance status or expected lenght of aplastic phase.