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1. Introduction
Patients with cancer have immune dysfunction either related to the underlying malignancy or as of result of treatment and this puts them at increased risk of developing life-threatening infections, particularly pneumonia [1], Indeed, 50% of cases of septic shock in cancer patients are caused by bacterial lung infection [2]. Additionally, patients with community-acquired pneumonia (CAP) that have an underlying diagnosis of cancer have worse outcomes irrespective of absolute neutropenia or the prognosis associated with the underlying malignancy [3,4], The characteristics of cancer patients with CAP admitted to intensive care units (ICUs) may partially explain the discrepancies in outcomes between patients with and without cancer, but are not well established. In this observational study we have compared the characteristics and outcomes of CAP patients with and without cancer admitted to our ICU.
2. Methods
2.1 Study design and setting
The reporting of this observational study is compliant with the standards of the STROBE Statement. A retrospective review of prospectively, routinely collected data of consecutively admitted patients to the ICU at the Royal Free Hospital, London, with a primary diagnosis of CAP (with or without a diagnosis of cancer) was undertaken as part of a service evaluation. The dataset included the period from January 2006 and October 2011. The Royal Free Hospital Research and Development department waived the need for patient consent. Patient records were de-identified prior to analysis.
2.2 Study population and data collection
Data of all inpatients with a coding diagnosis of pneumonia (bacterial pneumonia, viral pneumonia, fungal or yeast pneumonia or pneumonia, no organism isolated) was retrieved from our ICU database, which is part of the national intensive care database, the ICNARC (Intensive Care National Audit & Research Centre), UK. The CAP diagnosis was validated by reviewing all cases in the dataset. We included those cases with typical clinical symptoms consistent with respiratory infection (dyspnoea, cough, sputum production, fever [temperature ≥38°C]) and evidence of new radiographic shadowing within 48 hours of admission to hospital that was not known to be due to other causes. Patients with a previous hospital admission within 14 days and those admitted from nursing homes were excluded. To address issues with information bias, case notes review was carried out by the authors (AM, RJ, BA) and the information...