Survival of patients with solid tumours and sepsis admitted to intensive care in a tertiary oncology centre: a retrospective analysis
Author(s)
Type
Journal Article
Abstract
Introduction:
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with cancer are at risk of developing sepsis and requiring intensive care unit (ICU) admission. We aimed to assess survival of patients with a solid tumour admitted to ICU as an emergency with sepsis, and to identify predictors of 90-day survival at admission.
Materials and Methods:
We conducted a retrospective cohort survival analysis. We identified adults with a solid tumour admitted to ICU with sepsis between 01/01/2011 and 31/12/2020 at a tertiary oncology centre with two hospitals (London and Surrey, UK). We defined sepsis using the Sepsis-3 definition. The primary outcome was 90-day survival. We used the parametric accelerated failure time model for multivariate analysis to generate acceleration factors (AF).
Results:
625 patients were identified and the 90-day survival rate was 59.5%(353/593).Multivariate analysis identified the presence of localized (AF 0.13, 95% CI 0.06-0.25) or regionalized disease (AF 0.21, 95% CI 0.12-0.36) compared to distant metastatic disease, unplanned surgery on the day of admission (AF 0.15, 95% CI 0.07-0.31), lactate (AF 1.25 95% CI 1.15-1.35), Sequential Organ Failure Assessment Score (AF 1.19, 95% CI 1.12-1.27), previous radiotherapy (AF 1.89, 95% CI 1.14-3.125), previous systemic anti-cancer treatment (excluding hormonal therapy) (AF 1.49, 95% CI 0.93-2.38), bacteraemia (AF 0.47, 95% CI 0.27-0.81) and serum albumin (AF 0.94, 95% CI 0.91-0.98) as independent predictors of 90-day survival.
Conclusions:
This study of solid tumour patients admitted to ICU is one of the largest providing survival data to inform clinicians and patients. This data provides information on factors that should be considered when deliberating the possible outcome of ICU admission for a patient with solid malignancy and sepsis and highlights that the presence of cancer itself should not limit ICU admission for sepsis.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Patients with cancer are at risk of developing sepsis and requiring intensive care unit (ICU) admission. We aimed to assess survival of patients with a solid tumour admitted to ICU as an emergency with sepsis, and to identify predictors of 90-day survival at admission.
Materials and Methods:
We conducted a retrospective cohort survival analysis. We identified adults with a solid tumour admitted to ICU with sepsis between 01/01/2011 and 31/12/2020 at a tertiary oncology centre with two hospitals (London and Surrey, UK). We defined sepsis using the Sepsis-3 definition. The primary outcome was 90-day survival. We used the parametric accelerated failure time model for multivariate analysis to generate acceleration factors (AF).
Results:
625 patients were identified and the 90-day survival rate was 59.5%(353/593).Multivariate analysis identified the presence of localized (AF 0.13, 95% CI 0.06-0.25) or regionalized disease (AF 0.21, 95% CI 0.12-0.36) compared to distant metastatic disease, unplanned surgery on the day of admission (AF 0.15, 95% CI 0.07-0.31), lactate (AF 1.25 95% CI 1.15-1.35), Sequential Organ Failure Assessment Score (AF 1.19, 95% CI 1.12-1.27), previous radiotherapy (AF 1.89, 95% CI 1.14-3.125), previous systemic anti-cancer treatment (excluding hormonal therapy) (AF 1.49, 95% CI 0.93-2.38), bacteraemia (AF 0.47, 95% CI 0.27-0.81) and serum albumin (AF 0.94, 95% CI 0.91-0.98) as independent predictors of 90-day survival.
Conclusions:
This study of solid tumour patients admitted to ICU is one of the largest providing survival data to inform clinicians and patients. This data provides information on factors that should be considered when deliberating the possible outcome of ICU admission for a patient with solid malignancy and sepsis and highlights that the presence of cancer itself should not limit ICU admission for sepsis.
Date Issued
2025-01-28
Date Acceptance
2025-01-23
Citation
Journal of Intensive Care Medicine, 2025
ISSN
0885-0666
Publisher
SAGE Publications
Journal / Book Title
Journal of Intensive Care Medicine
Copyright Statement
© The Author(s) 2025. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
License URL
Sponsor
National Institute for Health Research
Identifier
10.1177/08850666241312621
Grant Number
NIHR303768
Subjects
Critical Care
Sepsis
cancer
intensive care
Publication Status
Published online
Date Publish Online
2025-01-28