High 28-day mortality in critically ill patients with sepsis and concomitant active cancer

J Int Med Res. 2018 Dec;46(12):5030-5039. doi: 10.1177/0300060518789040. Epub 2018 Aug 8.

Abstract

Objective: This study was performed to explore the characteristics and outcomes of patients with sepsis accompanied by active cancer who were admitted to the intensive care unit (ICU).

Methods: The baseline characteristics, infection profiles, and outcomes of patients with sepsis were retrospectively analyzed according to the presence of concomitant active cancer. The association between concomitant active cancer and 28-day mortality was explored.

Results: Of 23,956 patients with sepsis, 1574 (6.6%) had concomitant active cancer. The most common type was digestive (30.7%). The 28-day mortality ranged from 41.9% to 81.5%. Patients with active cancer had a significantly higher Simplified Acute Physiology Score II and significantly shorter length of ICU stay. Respiratory (32.9%), genitourinary (31.0%), and bloodstream (17.0%) infections were most common. Escherichia coli was the most frequent gram-negative pathogenic bacteria. The 28-day mortality rate was significantly higher in patients with than without active cancer. Concomitant active cancer was associated with increased 28-day mortality in patients with sepsis. Hematological malignancy was associated with a significantly higher risk of death than solid tumors.

Conclusions: Concomitant active cancer was associated with higher 28-day mortality in patients with sepsis requiring ICU admission. Hematological malignancy was associated with a higher risk of death than solid tumors.

Keywords: Sepsis; Simplified Acute Physiology Score II; active cancer; intensive care unit; mortality; outcome.

MeSH terms

  • Bacteremia / complications
  • Bacteremia / microbiology
  • Bacteremia / mortality*
  • Bacteremia / pathology
  • Critical Illness
  • Female
  • Gastrointestinal Neoplasms / complications
  • Gastrointestinal Neoplasms / microbiology
  • Gastrointestinal Neoplasms / mortality*
  • Gastrointestinal Neoplasms / pathology
  • Gram-Negative Bacteria / classification
  • Gram-Negative Bacteria / growth & development
  • Gram-Negative Bacteria / isolation & purification
  • Gram-Negative Bacteria / pathogenicity
  • Hematologic Neoplasms / complications
  • Hematologic Neoplasms / microbiology
  • Hematologic Neoplasms / mortality*
  • Hematologic Neoplasms / pathology
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Respiratory Tract Infections / complications
  • Respiratory Tract Infections / microbiology
  • Respiratory Tract Infections / mortality*
  • Respiratory Tract Infections / pathology
  • Retrospective Studies
  • Sepsis / complications
  • Sepsis / microbiology
  • Sepsis / mortality*
  • Sepsis / pathology
  • Survival Analysis
  • Urinary Tract Infections / complications
  • Urinary Tract Infections / microbiology
  • Urinary Tract Infections / mortality*
  • Urinary Tract Infections / pathology