Assessing the influence of neutropenia severity on mortality and adverse outcomes in chemotherapy-related septic shock.

Abstract

e15018 Background: Neutropenia, a common complication in cancer patients undergoing chemotherapy, significantly increases the risk of severe infections, including sepsis and septic shock. However, the prognostic impact of neutropenia on mortality in this patient population remains controversial, as recent studies have yielded conflicting results. This study aimed to investigate the impact of the severity of neutropenia on mortality in patients hospitalized with septic shock who had recently undergone chemotherapy. Methods: Using the TriNetX Research Database, we identified cancer patients (≥18 years) diagnosed with septic shock between January 1, 2013, and December 16, 2024. Eligible cancers included malignancies of the oral cavity, pharynx, larynx, stomach, kidney, bladder, skin, head, neck, and lung. Patients with chemotherapy within 6 weeks before or up to 2 weeks after septic shock and the diagnosis of neutropenia were stratified into two cohorts: Severe Neutropenia (Neutrophil count < 0.5 x103 μL but never between 0.5-1.5 x103 μL) and Mild neutropenia (neutrophil count between 0.5-1.5 x103 μL but never < 0.5x 103 μL). Propensity score matching (1:1) adjusted for confounders. Kaplan-Meier log-rank tests analyzed outcomes. Primary outcomes were mortality at 30, 60, 90 days, and 1 year respectively. Secondary outcomes included organ failure, and hospitalization or emergency services within 1 week to 1 month. Results: Through our study, we identified 44,052 cancer patients diagnosed with septic shock. Among these 4,284 patients were identified who had chemotherapy within the prespecified period. Among the chemotherapy patients, 1,980 were identified to have neutropenia, of which 163 patients had severe neutropenia and 908 patients had mild neutropenia. Mortality was consistently higher in severe neutropenia patients at 30 days (HR: 2.199, 95%CI: 1.56-3.1, p < 0.001), 60 days (HR: 1.79, 95%CI: 1.32-2.4, p < 0.001), 90-days (HR: 1.87, 95%CI: 1.39-2.51, p < 0.001), and at 1-year (HR: 1.65, 95%CI: 1.26-2.1, p < 0.001) respectively. Similarly, a significantly higher incidence of organ failure was noted in patients with severe neutropenia (HR: 1.49, 95%CI: 0.91-2.4, p = 0.035), But there was no significant difference between hospitalization/emergency services (HR = 0.909, p = 0.4062) Conclusions: Our study concluded that severe neutropenia ( < 0.5 x103 μL) in chemotherapy patients admitted with septic shock is associated with higher early and late mortality. It also led to an increased risk of organ failure in this population.