免疫抑制患者,尤其是那些患有癌症的人,代表了人口的重要组成部分,特别是随着人口增长和老龄化,癌症发病率上升。这些患者发生严重感染的风险更高,包括脓毒症和脓毒性休克,由于多种免疫缺陷,如中性粒细胞减少症,淋巴细胞减少,T和B细胞损伤。这些免疫图谱的多样性和复杂性,伴随使用免疫抑制疗法(例如,皮质类固醇,细胞毒性药物,和免疫疗法),叠加自然保护屏障的破损(例如,粘膜损伤,慢性留置导尿管,和解剖结构的改变),增加各种感染的风险。这些和其他模拟脓毒症的病症提出了实质性的诊断和治疗挑战。这些患者进展为脓毒性休克的风险增加的因素包括高龄,预先存在的合并症,脆弱,癌症的类型,免疫抑制的严重程度,低蛋白血症,低磷酸盐血症,革兰氏阴性菌血症,以及对初始治疗的反应类型和时机。由于有偏见的临床实践,可能导致延迟获得重症监护和更差的结果,对脓毒症或脓毒性休克的脆弱癌症患者的管理有所不同。虽然败血性休克通常与恶性肿瘤患者的不良预后相关,随着时间的推移,生存率显著提高。因此,通过新的范式理解和解决癌症患者的独特需求,其中包括将创新技术整合到我们的医疗保健系统中(例如,无线技术,医学信息学,精准医学),有针对性的管理策略,和强大的临床实践,包括早期识别和诊断,加上迅速进入促进多学科方法的高级护理设施,对于改善其预后和总体生存率至关重要。
Immunosuppressed patients, particularly those with cancer, represent a momentous and increasing portion of the population, especially as cancer incidence rises with population growth and aging. These patients are at a heightened risk of developing severe infections, including sepsis and septic shock, due to multiple immunologic defects such as neutropenia, lymphopenia, and T and B-cell impairment. The diverse and complex nature of these immunologic profiles, compounded by the concomitant use of immunosuppressive therapies (e.g., corticosteroids, cytotoxic drugs, and immunotherapy), superimposed by the breakage of natural protective barriers (e.g., mucosal damage, chronic indwelling catheters, and alterations of anatomical structures), increases the risk of various infections. These and other conditions that mimic sepsis pose substantial diagnostic and therapeutic challenges. Factors that elevate the risk of progression to septic shock in these patients include advanced age, pre-existing comorbidities, frailty, type of cancer, the severity of immunosuppression, hypoalbuminemia, hypophosphatemia, Gram-negative bacteremia, and type and timing of responses to initial treatment. The management of vulnerable cancer patients with sepsis or septic shock varies due to biased clinical practices that may result in delayed access to intensive care and worse outcomes. While septic shock is typically associated with poor outcomes in patients with malignancies, survival has significantly improved over time. Therefore, understanding and addressing the unique needs of cancer patients through a new paradigm, which includes the integration of innovative technologies into our healthcare system (e.g., wireless technologies, medical informatics, precision medicine), targeted management strategies, and robust clinical practices, including early identification and diagnosis, coupled with prompt admission to high-level care facilities that promote a multidisciplinary approach, is crucial for improving their prognosis and overall survival rates.