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Ann Am Thorac Soc. 2019 Dec 4. doi: 10.1513/AnnalsATS.201909-655OC. [Epub ahead of print]

Improvements in Sepsis-Associated Mortality in Hospitalized Cancer vs Non-Cancer Patients: A 12-Year Analysis Using Clinical Data.

Author information

1
Brigham and Women's Hospital, 1861, Medicine, Boston, Massachusetts, United States.
2
Brigham and Women's Hospital, Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States.
3
Harvard Medical School, 1811, Department of Population Medicine, Boston, Massachusetts, United States.
4
Dana Farber Cancer Institute, 1855, Boston, Massachusetts, United States.
5
Brigham and Women's Hospital , Boston, Massachusetts, United States.
6
Brigham and Women's Hospital, 1861, Medicine (Pulmonary and Critical Care), Boston, Massachusetts, United States.
7
Brigham and Women's Hospital, 1861, Department of Medicine, Boston, Massachusetts, United States; crhee@bwh.harvard.edu.

Abstract

RATIONALE:

There have been advances in both cancer and sepsis treatment over the past several decades, yet little is known about trends in sepsis-associated mortality in patients with versus without cancer.

OBJECTIVES:

To assess trends in sepsis-associated mortality in hospitalized patients with and without cancer using objective clinical criteria to identify sepsis and detailed clinical data to adjust for severity-of-illness.

METHODS:

This was a retrospective cohort study at a tertiary referral hospital and cancer center. Adult inpatients with clinical indicators of sepsis (CDC Adult Sepsis Event criteria) were identified between 2003 and 2014. Patients with cancer were identified using diagnosis codes from their hospitalization or the preceding 90 days. Sepsis-associated in-hospital mortality rates were assessed in 3-year intervals. Multivariable logistic regression models were used to adjust for case mix and severity-of-illness and to test for subgroup interactions in trends.

RESULTS:

The cohort included 20,975 sepsis patients, of whom 7,489 (35.7%) had cancer (61.7% solid, 38.3% hematologic). Sepsis-associated mortality rates in patients with cancer decreased from 31.3% in 2003-2005 to 26.0% in 2012-2014 (absolute decrease 5.2% [95% CI 2.3-8.2%]). This mortality reduction persisted after risk-adjustment (adjusted OR 0.53 [95% CI 0.45-0.63] in 2012-2014 relative to 2003-2005). In contrast, sepsis-associated mortality rates increased in patients without cancer from 20.9% in 2003-2005 to 23.9% in 2012-2014 (absolute increase 2.1% [95% CI 0.1-4.1%]) but were stable after risk-adjustment (adjusted OR 0.90 [95% CI 0.79-1.03%]) (p<0.001 for comparison of trends between patients with versus without cancer on both crude and adjusted analysis). Among patients with cancer, declines in risk-adjusted sepsis-associated mortality were observed in both solid and hematologic cancer subgroups, with both community-onset and hospital-onset sepsis, in patients receiving active cancer treatments, and in patients requiring mechanical ventilation at sepsis onset.

CONCLUSIONS:

Sepsis-associated mortality rates declined significantly over a 12-year period in patients with cancer but not in patients without cancer. Potential explanations include advances in the management of cancer and/or better sepsis treatments specifically in patients with cancer. Further research is needed to elucidate the reasons for our findings and to assess their generalizability to other hospitals.

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