Cancer Patients with Sepsis: Prognostic Insights from a Population-Based Cohort Study in Norway.

BACKGROUND

Patients with cancer who had sepsis experience a higher mortality risk than noncancer patients. However, it remains unclear how this risk varies with cancer type and metastasis status, sex, age, and infecting microbe.

METHODS

This nationwide cohort study included all noncancer patients and those with cancer ≥18 years hospitalized with sepsis in Norway from 2008 to 2021. Cancer status, sepsis, and hospital mortality were identified from the Norwegian Patient Registry (International Classification of Diseases 10th revision codes). Multivariable regression analyses estimated absolute and relative risks (RR) of hospital mortality across subgroups.

RESULTS

Of 222,832 hospitalized patients with sepsis, 37,692 (16.9%) had cancer. Hospital mortality was higher in patients with cancer, at 16.9% (males) and 16.2% (females) with nonmetastatic disease, and at 27.1% (males) and 26.2% (females) with metastatic disease. Compared with noncancer patients, adjusted RRs (95% confidence interval) of hospital death were 1.39 (1.34-1.44, males) and 1.63 (1.55-1.71, females) for nonmetastatic cancer and 2.27 (2.18-2.37, males) and 2.75 (2.62-2.89, females) for metastatic cancer. The type of cancer was a key prognostic factor. The association between cancer and mortality was strongest in metastatic patients below 50 years [males 40-49 years: RR, 5.94 (4.43-7.97); females 18-39 years: RR, 8.28 (5.12-13.37)] and in those with gram-negative sepsis.

CONCLUSIONS

The increased hospital mortality in patients with cancer varied with cancer type and the presence of metastasis. The association between cancer and mortality was strongest in females and young adults, as well as in gram-negative sepsis.

IMPACT: Knowledge of the specific aspects of sepsis in patients with cancer may improve cancer care and guide future research on targeted sepsis therapies.