Clinico-pathological profile of sepsis in patients with solid organ malignancies: A prospective observational study

Objectives: The objective of the study is to describe the clinico-pathological profile of sepsis in patients with solid organ malignancies using a Sepsis-3–aligned framework and to identify factors independently associated with progression to septic shock. Materials and Methods: This prospective observational study was conducted at a tertiary care teaching hospital over 2 years. Adult patients with histologically confirmed solid organ malignancies fulfilling Sepsis-3 criteria for sepsis were enrolled consecutively. Demographic data, tumor characteristics, infection source, microbiological findings, laboratory parameters, and Sequential Organ Failure Assessment (SOFA) scores at presentation were recorded. Patients were classified as having sepsis without shock or septic shock according to Sepsis-3 definitions. Multivariable logistic regression was used to identify independent predictors of septic shock. Results: Among 112 patients, 82 (73.2%) had sepsis without shock and 30 (26.8%) presented with septic shock. Higher admission SOFA score was the strongest independent predictor of septic shock. Gastrointestinal and pulmonary infection sources and stage III malignancy were also independently associated with shock. Individual laboratory parameters showed substantial overlap between groups. Patients with septic shock had significantly higher SOFA scores at presentation (10.4 ± 3.1 vs. 4.8 ± 1.9; p < 0.001), and in-hospital mortality was markedly higher in the shock group (43.3% vs. 11.0%; p < 0.001), despite overlap in isolated laboratory abnormalities. Culture-negative sepsis was frequent, particularly among patients with shock. Conclusion: In patients with solid organ malignancies, progression to septic shock is primarily driven by acute organ dysfunction, infection source, and tumor characteristics rather than demographic factors or isolated laboratory abnormalities. Structured SOFA-based assessment enables early risk stratification and may guide timely escalation of care in this high-risk population.