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Epidemiology and Outcomes of Cancer-Related Versus Non–Cancer-Related Sepsis Hospitalizations*

Hensley, Matthew K. MD1; Donnelly, John P. PhD2,3; Carlton, Erin F. MD4; Prescott, Hallie C. MD1,3

doi: 10.1097/CCM.0000000000003896
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Objective: Cancer and its treatment are known to be important risk factors for sepsis, contributing to an estimated 12% of U.S. sepsis admissions in the 1990s. However, cancer treatment has evolved markedly over the past 2 decades. We sought to examine how cancer-related sepsis differs from non–cancer-related sepsis.

Design: Observational cohort.

Setting: National Readmissions Database (2013–2014), containing all-payer claims for 49% of U.S. population.

Patients: A total of 1,104,363 sepsis hospitalizations.

Interventions: We identified sepsis hospitalizations in the U.S. National Readmissions Database using explicit codes for severe sepsis, septic shock, or Dombrovskiy criteria (concomitant codes for infection and organ dysfunction). We classified hospitalizations as cancer-related versus non–cancer-related sepsis based on the presence of secondary diagnosis codes for malignancy. We compared characteristics (site of infection and organ dysfunction) and outcomes (in-hospital mortality and 30-d readmissions) of cancer-related versus non–cancer-related sepsis hospitalizations. We also completed subgroup analyses by age, cancer types, and specific cancer diagnoses.

Measurements and Main Results: There were 27,481,517 hospitalizations in National Readmissions Database 2013–2014, of which 1,104,363 (4.0%) were for sepsis and 4,150,998 (15.1%) were cancer related. In-hospital mortality in cancer-related sepsis was 27.9% versus 19.5% in non–cancer-related sepsis. The median count of organ dysfunctions was indistinguishable, but the rate of specific organ dysfunctions differed by small amounts (e.g., hematologic dysfunction 20.1% in cancer-related sepsis vs 16.6% in non–cancer-related sepsis; p < 0.001). Cancer-related sepsis was associated with an adjusted absolute increase in in-hospital mortality ranging from 2.2% to 15.2% compared with non–cancer-related sepsis. The mortality difference was greatest in younger adults and waned with age. Patients (23.2%) discharged from cancer-related sepsis were rehospitalized within 30 days, compared with 20.1% in non–cancer-related sepsis (p < 0.001).

Conclusions: In this cohort of over 1 million U.S. sepsis hospitalizations, more than one in five were cancer related. The difference in mortality varies substantially across age spectrum and is greatest in younger adults. Readmissions were more common after cancer-related sepsis.

1Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI.

2Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI.

3Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI.

4Department of Pediatrics, Division of Critical Care Medicine, University of Michigan, Ann Arbor, MI.

*See also p.1452.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by grants K08 GM115859 (to Dr. Prescott) and K12 HL138039 (to Dr. Donnelly) from the National Institutes of Health.

Dr. Donnelly’s institution received funding from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute. Drs. Donnelly and Prescott received support for article research from the NIH. Dr. Prescott’s institution received funding from the NIH, and she disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: hematthe@med.umich.edu

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