Epidemiology and Prognosis of Sepsis in Cancer Patients: A Multicenter Prospective Observational Study

Abstract

Objectives To determine the epidemiology and prognosis of sepsis in cancer patients and the influence of sepsis on the mortality of cancer patients. Methods In this multicenter, prospective, observational study, cancer patients hospitalized without sepsis followed up until discharge or a maximum of 90 days were included. The incidence of sepsis in the follow-up period, risk factors for sepsis, risk factors for 28-day mortality in patients with sepsis and 90-day mortality in the entire group were determined. Results During the study, 790 cancer patients were included. Sepsis developed in 72 patients (9.1%) during the follow-up. Older age, hospitalization due to any infection, graft versus host diseases(GVHD), prolonged neutropenia, the presence of a urethral catheter, and previous bacterial infection in the last three months were risk factors of sepsis. Among all cancer patients, sepsis was found to be the most important factor influencing 90-day mortality (OR 13.42(1.79–6.83)). Mortality among the sepsis cohort was independently associated with an infection with a carbapenem-resistant bacterium (OR 15.47(1.45–64.17)), appropriateness of empirical treatment (OR 5.02 (0.17–7.61) and having a clinical improvement on the fifth day of the treatment (OR 10.58(0.39–28.25). Conclusions Sepsis was documented in one out of 11 hospitalized cancer patients and the mortality rate increases 13-fold when sepsis develops. Invasive devices, prolonged neutropenia, GVHD, and previous bacterial infections were related with sepsis and antibiotic resistance was the most important driver for mortality. Antimicrobial stewardship, rational use of catheters (if necessary, in accordance with asepsis/antisepsis, short-term use) is important to save lives in cancer patients.