All-cause mortality in cancer patients treated for sepsis in intensive care units: a systematic review and meta-analysis

Abstract

Purpose Sepsis is a common complication in patients with cancer, but studies evaluating the outcomes of critically ill cancer patients with sepsis on a global scale are limited. We aimed to summarize the existing evidence on mortality rates in this patient population. Methods Prospective and retrospective observational studies evaluating critically ill adult cancer patients with sepsis, severe sepsis, and/or septic shock were included. Studies published from January 2010 to September 2021 that reported at least one mortality outcome were retrieved from MEDLINE (Ovid), Embase (Ovid), and Cochrane databases. Study selection, bias assessment, and data collection were performed independently by two reviewers, and any discrepancies were resolved by a third reviewer. The risk of bias was assessed using the Newcastle–Ottawa scale. We calculated pooled intensive care unit (ICU), hospital, and 28/30-day mortality rates. The heterogeneity of the data was tested using the chi-square test, with a P value < 0.10 indicating significant heterogeneity. Results A total of 5464 citations were reviewed, of which 10 studies met the inclusion criteria; these studies included 6605 patients. All studies had a Newcastle–Ottawa scale score of 7 or higher. The mean patient age ranged from 51.4 to 64.9 years. The pooled ICU, hospital, and 28/30 day mortality rates were 48% (95% CI, 43– 53%; I 2 = 80.6%), 62% (95% CI, 58–67%; I 2 = 0%), and 50% (95% CI, 38– 62%; I 2 = 98%), respectively. Substantial between-study heterogeneity was observed. Conclusion Critically ill cancer patients with sepsis had poor survival, with a hospital mortality rate of about two-thirds. The substantial observed heterogeneity among studies could be attributed to variability in the criteria used to define sepsis as well as variability in treatment, the severity of illness, and care across settings. Our results are a call to action to identify strategies that improve outcomes for cancer patients with sepsis. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07392-w.

Association between site of infection and mortality in patients with cancer with sepsis or septic shock: A retrospective cohort study

“…Although infection is the most common cause of in-hospital mortality in patients with cancer ( 11 ), to the best of our knowledge, there are no previous studies examining the influence of infection sites on patients with cancer.…”

Sepsis and acute respiratory failure in patients with cancer: how can we improve care and outcomes even further?

“…Studies of critically ill oncology patients with sepsis or septic shock have yielded analogous findings. Recently, Nazer et al conducted a systematic review and meta-analysis of cancer patients treated for sepsis in intensive care units [39 ▪▪ ]. In 10 studies including 6605 patients, pooled ICU and hospital mortality were approximately 50% and 60%, respectively.…”

“…We believe this approach has particular value in oncologic critical care, as atypical presentations of common conditions, oncology-specific pathologies, and “mimic” conditions frequently present diagnostic and management challenges (e.g., cytokine release syndrome) [82–85]. In terms of oncologic sepsis, for example, the meta-analysis from Nazer et al noted substantial between-study heterogeneity, likely attributable to variable sepsis definitions, clinical case mix, and treatment approaches [39 ▪▪ ]. Cancer itself is a heterogeneous set of disease states from numerous clinical and -omics perspectives [86–89], adding an additional dimension through which heterogeneity of treatment effect might manifest in the ICU.…”

Sepsis mortality among patients with haematological malignancy admitted to intensive care 2000–2022: a binational cohort study

“…Both haematological malignancies and their treatments predispose to infection, and sepsis is reported in 12–27% of patients with haematological malignancy within the first year of treatment [ 1 ]. Admission to an Intensive Care Unit (ICU) is required in up to 15% [ 2 ], and short term mortality is reported at 30–60% [ 3 , 4 ]. Among those who recover, consequences extend well beyond the initial episode, due to delays to life-saving cancer therapy, prolonged antimicrobial exposure, and colonisation with multi-resistant organisms [ 5 ].…”