The evolution of mortality from sepsis in patients with cancer: A systematic review and meta-analysis

Background: Increasing numbers of patients with cancer are being admitted to intensive care units (ICU) with sepsis. The mortality from sepsis and septic shock in these patients is unclear. This study aimed to establish mortality from sepsis and septic shock in patients with cancer admitted to ICU and assess mortality trends over time. Methods: We conducted a literature search using MEDLINE and EMBASE. Included studies enrolled adult patients with cancer admitted to ICU with sepsis or septic shock and reported outcomes of interest. Studies were assessed using the Newcastle-Ottawa Scale for risk of bias and the quality assessment tool for observational cohort and cross-sectional studies. We performed a meta-analysis to estimate pooled ICU, hospital and 30-day mortality from sepsis and septic shock and a multivariate meta-regression to assess mortality trends over time. The study was registered on PROSPERO (CRD42022341277). Results: Twenty-five articles were included. The pooled ICU, hospital and 30-day mortality for sepsis was 44% (95% CI 38%–50%), 54% (95% CI 49%–60%) and 49% (95% CI 44%–55%) respectively. The pooled ICU, hospital and 30-day mortality for septic shock was 51% (95% CI 45%–57%), 62.6% (95% CI 56%–69%) and 54% (95% CI 46%–61%) respectively. There was significant heterogeneity between studies. The meta-regression identified decreasing ICU and hospital mortality from sepsis, and decreasing ICU mortality from septic shock. Conclusion: Patients with cancer admitted to ICU with sepsis face a significant mortality risk greater than that of the general population, despite decreasing mortality over time. Further research is required to improve outcomes.