- Design
- Systematic review and random-effects meta-analysis
- Population
- 105 studies, about 20 million adults with sepsis or septic shock
- Primary outcome
- All-cause mortality by endpoint
- 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 pooled 105 studies, over 20 million participants, comparing mortality in adults with sepsis or septic shock with and without malignancy, and separated the results by endpoint.
Malignancy was associated with higher in-hospital (OR 1.90), early (OR 1.81), intermediate (OR 2.28) and extended follow-up mortality (OR 2.41). The ICU mortality estimate crossed 1. Associations were most consistent for haematological cancers; metastatic disease raised early and in-hospital deaths; solid tumours carried a smaller excess.
These are crude, unadjusted estimates, so they describe prognosis rather than a cause. For the ward physician, the value is in conversations: patients with cancer and sepsis are at higher risk of dying in hospital and in the months after, which should shape goals-of-care discussions early rather than after a deterioration.
- Raise goals of care early in patients admitted with sepsis and active cancer.
- Expect higher risk with haematological and metastatic disease than with localised solid tumours.
- Do not withhold standard sepsis care on the basis of a cancer diagnosis alone.
- Plan follow-up after discharge, when excess mortality persists.
Why it matters
The excess risk extends beyond the ICU and the admission, where planning often stops.
Don't overread it
The estimates are unadjusted — they show who is at risk, not that cancer itself causes the excess deaths.
The statistics, in plain English
An OR of 1.90 means the odds of dying in hospital were nearly twice as high with malignancy. Odds ratios overstate risk when deaths are common, and the authors note risk ratios were smaller.
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