Subsequent risk of death from sepsis among over 6 million cancer patients: A population-based cohort study

Sepsis, a severe systemic inflammatory response to infection, remains a leading cause of morbidity and mortality among cancer patients, particularly due to the immunosuppressive effects of both malignancy and its treatments. This study aims to assess the risk of sepsis-related mortality in cancer patients, identify the effects of various cancer types and demographic factors, and provide insights for developing targeted preventive strategies.

A population-based cohort study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) database, which includes approximately 26.5 % of the U.S.

The analysis covered 6,891,191 cancer patients diagnosed from 2000 to 2021. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) were calculated to compare sepsis-related mortality risk in cancer patients with the general population. Key variables included cancer type, age, gender, race, and marital status.

Of the 6,891,191 cancer patients included, 25,232 (0.37 %) died from sepsis. The overall SMR was 1.52 (95 % CI: 1.50-1.54), with an AER of 2.15 (95 % CI: 2.05-2.25) per 10,000 person-years. Patients with brain and other nervous system cancers (SMR = 5.74, 95 % CI: 4.95-6.61), respiratory system cancers (SMR = 3.52, 95 % CI: 3.38-3.66), and hematologic malignancies such as myeloma (SMR = 3.25, 95 % CI: 2.97-3.55) exhibited high sepsis-related mortality risks. Disparities were observed, with elevated risks in female patients (SMR = 1.64, 95 % CI: 1.61-1.67), American Indian/Alaska Native patients (SMR = 4.23, 95 % CI: 3.50-5.07), and single (never married) individuals (SMR = 2.50, 95 % CI: 2.42-2.58). Mortality risk was most pronounced within the first two months following cancer diagnosis, with an SMR of 7.37 (95 % CI: 7.14-7.61).

The findings suggest a significantly increased risk of sepsis-related mortality among cancer patients, highlighting the need for improved infection prevention, early interventions, and tailored strategies. Multidisciplinary care and enhanced support for high-risk groups are essential to mitigate sepsis-related complications and improve outcomes.