Cancer patients with sepsis: Prognostic insights from a population-based cohort study in Norway

Background: Cancer patients with sepsis experience a higher mortality risk than non-cancer patients. However, it remains unclear how this risk varies with cancer type and metastasis status, sex, age, and infecting microbe. Methods: This nationwide cohort study included all cancer and non-cancer patients ≥18 years hospitalized with sepsis in Norway from 2008 to 2021. Cancer status, sepsis, and hospital mortality were identified from the Norwegian Patient Registry (ICD-10 codes). Multivariable regression analyses estimated absolute and relative risks of hospital mortality across subgroups. Results: Of 222,832 hospitalized sepsis patients, 37,692 (16.9%) had cancer. Hospital mortality was higher in cancer patients, at 16.9% (males) and 16.2% (females) with non-metastatic disease, and 27.1% (males) and 26.2% (females) with metastatic disease. Compared to non-cancer patients, adjusted relative risks RR (95%CI) of hospital death were 1.39 (1.34-1.44, males) and 1.63 (1.55-1.71, females) for non-metastatic cancer, and 2.27 (2.18-2.37, males) and 2.75 (2.62-2.89, females) for metastatic cancer. The type of cancer was a key prognostic factor. The association between cancer and mortality was strongest in metastatic patients under 50 years ((males 40–49 years: RR 5.94 (4.43-7.97), females 18–39 years: RR 8.28 (5.12-13.37), and in those with Gram-negative sepsis. Conclusions: The increased hospital mortality in cancer patients varied with cancer type and presence of metastasis. The association between cancer and mortality was strongest in females and young adults as well as in Gram-negative sepsis. Impact: Knowledge of the specific aspects of sepsis in cancer patients may improve cancer care and guide future research on targeted sepsis therapies.