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
ARTICLE HIGHLIGHTS
Research 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.

Research motivation

Despite the high incidence of cancer and sepsis in the global population, there has been limited research on the impact of cancer on outcomes of patients with sepsis. It would be pertinent to understand if cancer as a comorbidity impacts survival in patients with sepsis so that appropriate measures could be taken to reduce the incidence of adverse outcomes.

Research objectives

The purpose of our study was to assess if cancer increases the mortality rates in sepsis patients by pooling evidence from contemporary studies.

Research 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 was pooled using odds ratio (OR) and 95% confidence intervals (CI) in a random-effects model. Meta-regression was conducted to assess the influence of confounders on mortality rates.

Research results

Nine studies were included. 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 cancer patients 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.

Research conclusions

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.

Research perspectives

Cancer patients with sepsis should be considered as a high-risk group for mortality. These patients should receive intensive therapy and highly-monitored treatment.