Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2022; 10(21): 7386-7396
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7386
Impact of cancer on mortality rates in patients with sepsis: A meta-analysis and meta-regression of current studies
Mei-Jiao Xiang, Guo-Liang Chen
Mei-Jiao Xiang, Department of Comprehensive Intensive Care Unit, Jinhua People’s Hospital, Jinhua 321000, Zhejiang Province, China
Guo-Liang Chen, Department of Hepatobiliary Pancreatic Gastrointestinal Surgery, Jinhua People's Hospital, Jinhua 321000, Zhejiang Province, China
Author contributions: Xiang MJ conceived and designed the study; Xiang MJ and Chen GL were involved in literature search and data collection; Chen GL analyzed the data; Xiang MJ and Chen GL wrote the paper; Xiang MJ edited the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Liang Chen, MD, Doctor, Department of Hepatobiliary Pancreatic Gastrointestinal Surgery, Jinhua People's Hospital, No. 267 Danxi East Road, Jinhua 321000, Zhejiang Province, China. glchenjh@163.com
Received: January 4, 2022
Peer-review started: January 4, 2022
First decision: February 21, 2022
Revised: March 4, 2022
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: July 26, 2022
Processing time: 188 Days and 1.2 Hours
Abstract
BACKGROUND

Research suggests that approximately 6% of adult patients admitted to hospitals in the United States present with sepsis and there has been a minimal change in the incidence of this condition in the last decade. Furthermore, patients with cancer generally have a higher incidence of sepsis due to immunosuppression caused by cancer or its treatment.

AIM

To assess if cancer increases the mortality rates in sepsis patients by pooling evidence from contemporary studies.

METHODS

PubMed, Embase, and Google Scholar databases were searched from January 1, 2001 to December 15, 2021 for studies comparing outcomes of sepsis patients based on the presence of active cancer. Mortality data were pooled using a random-effects model, with the odds ratio (OR) and 95% confidence interval (CI) calculated. Meta-regression was conducted to assess the influence of confounders on mortality rates.

RESULTS

Nine studies were included. The meta-analysis demonstrated a non-significant tendency towards increased risk of early mortality (OR = 2.77, 95%CI: 0.88-8.66, I2 = 99%) and a statistically significantly increased risk of late mortality amongst sepsis patients with cancer as compared to non-cancer sepsis patients (OR = 2.46, 95%CI: 1.42-4.25, I2 = 99%). Overall, cancer was found to significantly increase the risk of mortality in sepsis patients (OR = 2.7, 95%CI: 1.07-6.84, I2 = 99%). Meta-analysis indicated a statistically significantly increased risk of mortality in patients with solid tumors as well as hematological malignancies. Meta-regression indicated that an increase in the prevalence of comorbid pulmonary and renal diseases increased the risk of mortality in cancer patients with sepsis. Mortality rates increased with an increase in the percentage of patients with urinary tract infections while an inverse relationship was seen for infections of cutaneous origin.

CONCLUSION

Contemporary evidence indicates that the presence of any cancer in sepsis patients significantly increases the risk of mortality. Scarce data suggest that mortality is equally increased for both solid and hematological cancers. Current evidence is limited by high heterogeneity and there is a need for further studies taking into account several confounding variables to present better evidence.

Keywords: Sepsis; Septic shock; Malignancy; Immunocompromised; Mortality

Core Tip: Therapeutic advances in the past two decades have resulted in several advances in the management of cancer as well as sepsis patients. However, it is unclear if active cancer results in worse clinical outcomes in sepsis patients. We pooled the data from nine recent studies to demonstrate that cancer results in a 2.7 times increased risk of mortality in sepsis patients. The outcomes are similar for both solid tumors and hematological cancers. There is a need for further research taking into account several confounding variables to present better evidence.