Neutropenic sepsis in the Intensive Care Unit: differences in clinical profile and outcomes according to the cause of neutropenia

Abstract

Neutropenic sepsis frequently requires admission to an Intensive Care Unit (ICU). Differences between subgroups of patients with neutropenic sepsis are not well characterised. To investigate clinical outcomes among patients with neutropenic sepsis and haematological malignancy, metastatic solid cancer, or no cancer diagnosis. Retrospective cohort study of all patients admitted to ICU in Australia or New Zealand between January 2000 and December 2022 with a primary admission diagnosis of sepsis and total white cell count <1.0 × 109cells/L. We identified 8,617 ICU admissions with neutropenic sepsis (Haematological malignancy n = 4,660; metastatic solid cancer n = 1,034; no cancer n = 2,800). Patients with haematological malignancy were younger (median 61.5 years) with low rates of chronic comorbidities (4.7%), and were usually admitted to ICU from the ward (67.4%). Mechanical ventilation rates were 20.2% and in-hospital mortality was 30.6%. Patients with metastatic solid cancers were older (median 66.3 years), with higher rates of chronic comorbidities (9.9%), and were usually admitted to ICU from the emergency department (50.8%). Mechanical ventilation rates were 16.9% and in-hospital mortality was 42.4%. Patients with no documented cancer had highest rates of mechanical ventilation (41.7%) and mortality (46.3%). Neutropenia was independently associated with mortality among patients with solid cancers or no cancer, but did not confer increased risk among patients with haematological malignancy (OR 0.98, 95% CI 0.90–1.06, p = 0.60). Patients with neutropenic sepsis and haematological malignancy, metastatic solid cancer, or no cancer diagnosis constitute three distinct clinical groups. Management approaches should be tailored accordingly.