Mortalidade de pacientes oncológicos com sepse como ferramenta para prática de enfermagem em terapia intensiva: estudo de coorte

Abstract

This study focuses on the mortality of cancer patients diagnosed with sepsis as a tool for monitoring and guiding nursing practice in intensive care units. Cancer patients are more likely to develop sepsis compared to the general population. The mechanisms underlying increased mortality in patients with cancer and sepsis are multifactorial in nature. Cancer treatment can alter the host's immune response, which can result in a greater predisposition to infection. When correlated with cancer patients, the risk of sepsis can be increased tenfold when compared to patients without cancer. Objective: To analyze the mortality of cancer patients diagnosed with sepsis compared to those without sepsis admitted between 2020 and 2023 in the intensive care unit from the perspective of nursing practice. Method: This is an observational study with a cohort design, carried out using data from the Intensive Care Unit of a University hospital located in Rio de Janeiro, RJ, Brazil. The inclusion criteria were patients aged 18 years or over, diagnosed with a solid, hematological and/or metastasis tumor. The sociodemographic and clinical characterization was demonstrated through absolute (n) and relative frequency (%). Data collection between February and May 2024. This study was approved by the Research Ethics Committee. Results: 1249 cancer patients were analyzed, of which 866 (69.33%) did not have a diagnosis of sepsis and 382 (30.67%) had sepsis described in their medical records. The mortality rate in the general population of cancer patients was calculated at 26.60%. When this outcome was observed in relation to the presence of sepsis, it was observed that in cancer patients with sepsis the mortality rate was 52.62%. The relationship between comorbidities and mortality in cancer patients identified a greater chance of death in the presence of Chronic Obstructive Pulmonary Disease (Odds Ratio 79.3%) and smoking (Odds Ratio 76.9%). Dialysis patients have a 2.4 times greater chance of death regardless of the presence of sepsis. Diabetes Melitus was evidenced as a comorbidity that increases the chance of death in cancer patients with sepsis by 46.3%. Conclusion: In intensive care units, nursing plays a crucial role in the early detection of sepsis. Constant monitoring of patient-specific signs, evaluation of laboratory parameters and careful observation of clinical changes. Despite improvements in the survival of cancer patients, mortality for those diagnosed with sepsis is still significantly high. Early detection and quick decision-making affect the patient's prognosis.