HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Danai, P. A. Articles by Martin, G. S. Search for Related Content PubMed PubMed Citation Articles by Danai, P. A. Articles by Martin, G. S.

The Epidemiology of Sepsis in Patients With Malignancy^*

^* From the Division of Pulmonary, Allergy, and Critical Care (Drs. Danai, Moss, and Martin), Emory University School of Medicine, Atlanta, GA; and Division of Pulmonary and Critical Care (Dr. Mannino), University of Kentucky, Lexington, KY.

Correspondence to: Greg S. Martin, MD, MSc, FCCP, Assistant Professor of Medicine, 49 Jesse Hill Jr Dr SE, Atlanta, GA 30303; e-mail: Greg.Martin{at}emory.org

Abstract

Study objectives: To evaluate the longitudinal epidemiology of sepsis in patients with a history of cancer and to specifically examine sepsis-related disparities in risk or outcome.

Design: Sepsis cases from 1979 through 2001 using a nationally representative sample of nonfederal acute-care hospitalizations in the United States (the National Hospital Discharge Survey) integrated with cancer prevalence from the Surveillance, Epidemiology, and End Results database.

Setting: Eight hundred fifty-four million acute-care hospitalizations and 8.9 million patients with cancer.

Patients or participants: Patients with a history of cancer hospitalized with a diagnosis of sepsis.

Measurements and results: From 1979 to 2001, there were a total of 1,781,445 cases of sepsis in patients with cancer, yielding a mean annual incidence rate of 1,465 cases per 100,000 cancer patients and a relative risk [RR] of 9.77 compared to noncancer patients (95% confidence interval [95% CI], 9.67 to 9.88). In contrast to the absolute number of cases, the incidence rate of sepsis decreased over time, from a peak of 1,959 cases per 100,000 cancer patients in 1987 to 995 cases per 100,000 in 2001. The distribution of infectious sources causing sepsis was associated with the type of malignancy. White cancer patients had a lower risk for sepsis compared to nonwhites (African-American RR, 1.28; 95% CI, 1.16 to 1.40) and other races (RR, 1.47; 95% CI, 1.22 to 1.72); and male cancer patients had a higher risk for sepsis compared to female cancer patients (male RR, 1.17; 95% CI, 1.10 to 1.23). Cancer was an independent predictor of death among sepsis patients by multivariable analysis (adjusted odds ratio for death, 1.98; 95% CI, 1.97 to 1.99).

Conclusions: Patients with a history of cancer are at increased risk for acquiring and subsequently dying from sepsis, compared to the general population, although incidence and fatality rates are decreasing over time. There are significant racial and gender disparities in the incidence and outcome of sepsis among cancer patients that require explanation.

Key Words: cancer • disparity • epidemiology • malignancy • outcomes • sepsis

This article has been cited by other articles:

				A. P. Wheeler Recent Developments in the Diagnosis and Management of Severe Sepsis Chest, December 1, 2007; 132(6): 1967 - 1976. [Abstract] [Full Text] [PDF]

				Epidemiology of Sepsis in Cancer Patients Journal Watch Infectious Diseases, July 12, 2006; 2006(712): 9 - 9. [Full Text]