Cancer was associated with roughly double the odds of death in sepsis

Design

Systematic review and random-effects meta-analysis of observational studies

Population

85 studies of adults with sepsis or septic shock, with and without malignancy

Primary outcome

All-cause mortality by endpoint (ICU, in-hospital, early, intermediate, extended)

Effect

In-hospital OR 1.90 (1.69–2.13); extended follow-up OR 2.41 (1.70–3.42); ICU OR 1.21 (0.94–1.56)

A systematic review and meta-analysis in Annals of Medicine, published on 30 October, pooled 85 studies comparing mortality in adults with sepsis or septic shock with and without malignancy. It separated mortality by time point rather than lumping endpoints together.

Odds of in-hospital death were about 1.9 times higher with cancer, early death about 1.8 times, and death at longer follow-up about 2.3 to 2.4 times. ICU mortality alone was not clearly raised. The link was sustained over time for haematological malignancy, concentrated early for metastatic disease, and smaller for solid tumours.

The estimates are crude and unadjusted, so they describe prognosis, not the effect of cancer itself, and severity of illness probably explains part of the gap. They should not be used on their own to withhold intensive care.

The practical use is in conversations: setting expectations for families, and recognising that the risk persists beyond the ICU stay, especially in haematological cancer.

• Expect higher in-hospital and later mortality in septic patients with haematological cancer.
• Metastatic solid cancer carried most of its excess risk early in the admission.
• Do not use cancer status alone to decide on ICU admission; these figures are unadjusted.
• Plan follow-up after discharge for septic patients with cancer, as the excess risk continues.
• Involve the treating oncologist early in goals-of-care discussions.

Why it matters

It shows the excess risk extends well past the ICU, which changes what follow-up and family conversations should cover.

Don't overread it

The pooled estimates are unadjusted; they do not show cancer independently causes the excess deaths.

The statistics, in plain English

An odds ratio of 1.90 (95% CI 1.69 to 2.13) for in-hospital death is precise because many studies contributed. Odds ratios overstate relative risk when deaths are common, as they are in sepsis; the authors note that risk ratios were smaller.

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