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Assessment of clinical features and determinants of mortality among cancer patients with septic shock of pulmonary origin: a prospective analysis
  1. Maria Rasheed1,
  2. Yusra Habib Khan2,
  3. Ghulam Mujtaba3,
  4. Tauqeer Hussain Mallhi2,
  5. Malik Saadullah4,
  6. Amna Saifullah1
  1. 1 Institute of Pharmacy, Lahore College for Women University, Lahore, Punjab, Pakistan
  2. 2 Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Kingdom of Saudi Arabia
  3. 3 Department of Pharmacy, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Punjab, Pakistan
  4. 4 Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Punjab, Pakistan
  1. Correspondence to Dr Yusra Habib Khan, Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Skaka, 72341, Al-Jouf, Kingdom of Saudi Arabia; yusrahabib{at}; Dr Tauqeer Hussain Mallhi, Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, 72341, Al-Jouf, Kingdom of Saudi Arabia; tauqeer.hussain.mallhi{at}


Background Pneumonia-associated septic shock (PASS) in patients with cancer inflicts healthcare burden attributed to high morbidity and mortality. Current study was aimed to evaluate the clinical outcomes, microbiological characteristics, risk factors and impact of life-support interventions on 28-day mortality among cancer patients with PASS.

Methods A prospective observational study was conducted among cancer patients with PASS admitted to intensive care unit (ICU) of ‘Shaukat Khanum Memorial Cancer Hospital’. Data were analysed using appropriate statistical methods.

Results Out of 100 patients who sought medical care during the study period, 59 (59%) were male and majority had solid tumour than haematological malignancies (68% vs 32%). Nosocomial pneumonia was most frequent (90%) followed by healthcare-associated pneumonia (HCAP) (9%) and community-acquired pneumonia (CAP) (1%). The most common causative pathogen was Pseudomonas aeruginosa, 21 (32%). Overall mortality rate was 76% including 15% hospital and 61% ICU mortality. Sequential Organ Failure Assessment (SOFA) score at first day (HR 3.8; 95% CI 1.7 to 8.9; p=0.002), SOFA score at seventh day (HR 8.9; 95% CI 3.6 to 22.7; p=<0.001), invasive mechanical ventilation (HR 8.0; 95% CI 3.2 to 20; p<0.001) and performance status (HR 5.4; 95% CI 2.5 to 11.3; p<0.001) were found to be independently associated with 28-day mortality. Receiver operating characteristic curve analysis accentuates the excellent predictive accuracy of Cox regression model for mortality indicated by area under the curve of 0.892 (95% CI 0.801 to 0.983, p<0.001).

Conclusion Our analysis demonstrates substantial mortality associated with PASS among patients with cancer. Timely recognition of patients with high predilection of increased mortality could be of value in improving the disease burden.

  • cancer
  • pneumonia
  • septic shock
  • pneumonia associated septic shock
  • SOFA score
  • mortality

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  • YHK and THM contributed equally.

  • Contributors YHK and MR: conceptualisation. YHK, GM and THM: methodology.

    THM and MS: formal analysis. MR and AS: investigation. MR, MS and GM: data curation. MR and THM: writing – original draft preparation. THM and AS: writing – review and editing. YHK and GM: supervision. YHK: project administration.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved (No.: SKMCH/ERB/2018/0278) by ethics committee of Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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