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<p>Because cancer may affect sepsis prognosis, yet its association as a comorbidity remains unclear, this study aimed to evaluate the association between pre-existing cancer and mortality in critically ill septic patients. This retrospective cohort study utilized the Medical Information Mart for Intensive Care IV version 3.0 database (2008–2022), focusing on adult ICU patients with sepsis and underlying cancer as the exposure variable. The primary outcome was 28-day all-cause mortality, analyzed using 1:1 propensity score matching (PSM). We acknowledge that detailed oncological information (cancer type, stage, treatment) was unavailable from the database, which may introduce heterogeneity and affect result interpretation. The original cohort included 16,057 patients with sepsis but not cancer and 2,674 with sepsis and cancer. After PSM, both groups were balanced with 2,673 patients. The cancer group had a greater 28-day all-cause mortality rate as compared to the non-cancer group (35.84% vs. 18.97%, respectively), with a hazard ratio (HR) of 2.09 (95% confidence interval [CI]: 1.878~ 2.33, <i>p</i> &lt; 0.001). Sensitivity analysis showed a consistently elevated risk (HR = 1.39, 95% CI: 1.211 ~ 1.586, <i>p</i> &lt; 0.001). Furthermore, cancer was associated with increased in-hospital and 90-day mortality rates among sepsis patients. Subgroup analyses showed elevated mortality risk for sepsis patients with pre-existing cancer relative to non-cancer patients regardless of stratification by age, sex, Charlson Comorbidity Index score (CCI), Sequential Organ Failure Assessment score(SOFA), lymphocyte count, mechanical ventilation requirement,norepinephrine status or acute kidney injury within 48&#xa0;h of ICU admission. Among critically ill patients with sepsis, underlying cancer is associated with a higher 28-day all-cause mortality. This association does not imply causation. Further prospective studies are warranted to validate these findings.</p><p><b>Clinical trial number</b>: This study was registered with the Chinese Clinical Trial Registry on April 22, 2025 (registration number: ChiCTR-PID-270259).</p>

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Impact of cancer on mortality in critically ill patients with sepsis: a propensity score-matched analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月14日

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  • Lingyu Jiang,
  • Xiangjie Duan,
  • Jing Pang,
  • Yonglong Zhong,
  • Haiyan Yin,
  • Lin Han,
  • Shulin Xiang

摘要

Because cancer may affect sepsis prognosis, yet its association as a comorbidity remains unclear, this study aimed to evaluate the association between pre-existing cancer and mortality in critically ill septic patients. This retrospective cohort study utilized the Medical Information Mart for Intensive Care IV version 3.0 database (2008–2022), focusing on adult ICU patients with sepsis and underlying cancer as the exposure variable. The primary outcome was 28-day all-cause mortality, analyzed using 1:1 propensity score matching (PSM). We acknowledge that detailed oncological information (cancer type, stage, treatment) was unavailable from the database, which may introduce heterogeneity and affect result interpretation. The original cohort included 16,057 patients with sepsis but not cancer and 2,674 with sepsis and cancer. After PSM, both groups were balanced with 2,673 patients. The cancer group had a greater 28-day all-cause mortality rate as compared to the non-cancer group (35.84% vs. 18.97%, respectively), with a hazard ratio (HR) of 2.09 (95% confidence interval [CI]: 1.878~ 2.33, p < 0.001). Sensitivity analysis showed a consistently elevated risk (HR = 1.39, 95% CI: 1.211 ~ 1.586, p < 0.001). Furthermore, cancer was associated with increased in-hospital and 90-day mortality rates among sepsis patients. Subgroup analyses showed elevated mortality risk for sepsis patients with pre-existing cancer relative to non-cancer patients regardless of stratification by age, sex, Charlson Comorbidity Index score (CCI), Sequential Organ Failure Assessment score(SOFA), lymphocyte count, mechanical ventilation requirement,norepinephrine status or acute kidney injury within 48 h of ICU admission. Among critically ill patients with sepsis, underlying cancer is associated with a higher 28-day all-cause mortality. This association does not imply causation. Further prospective studies are warranted to validate these findings.

Clinical trial number: This study was registered with the Chinese Clinical Trial Registry on April 22, 2025 (registration number: ChiCTR-PID-270259).