Survival of patients with solid tumors and sepsis admitted to intensive care in a tertiary oncology center: A retrospective analysis.
Authors: Smith Sam , Edwards Luke , Wigmore Timothy , Jhanji Shaman , Antcliffe David , Tatham Kate 
Published: June 2023

6586

Background: Sepsis is a life threatening organ dysfunction caused by a dysregulated host response to infection. Patients with cancer are at high risk of developing sepsis and requiring admission to the intensive care unit (ICU). Patients with cancer and sepsis have been found to have worse survival than non-cancer patients, with 90 day survival for cancer patients ranging from 28% to 72%. Survival differs between studies due to multiple factors including variably mixed haemato-oncology and solid tumor cohorts and varying definitions of sepsis. Our objectives were to accurately assess short, medium and long term survival of patients admitted to ICU with a solid tumor and sepsis and to identify the best predictors of 90 day survival at admission. Methods: We conducted a retrospective cohort survival analysis. We identified adults (aged 18 years and over) admitted to ICU with sepsis and a solid tumor between 1st January 2011 and 31st December 2020 at a tertiary oncology center with hospitals at two sites (London and Surrey, United Kingdom). We defined sepsis using the Sepsis-3 definition. The primary outcome was 90 day survival, but we also calculated 30 day, 180 day, 1 year and 5 year survival. Survival was calculated excluding patients lost to follow up. Univariate and multivariate analyses were undertaken to identify factors that differed between survivors and non-survivors at day 90. We used the parametric accelerated failure time model for multivariate analysis to generate time ratios (TR). Results: 625 patients were identified, with 131 patients lost to follow up by 5 years. The median age was 64 years (Interquartile Range 54-71) and 56% were male. 84.8% (530/625) survived to ICU discharge. The 30, 90 and 180 day survival rates were 72% (439/610), 59.5% (353/593) and 51.7% (300/580) respectively. 1 year survival was 38.7% (221/571) and 5 year survival 8.1% (40/494). Multivariate analysis identified the presence of localized (TR 7.85, 95% CI 4.00 -15.41) or regionalized disease (TR 4.71, 95% CI 2.74-8.08) compared to distant metastatic disease, surgery on the day of admission (TR 6.78, 95% CI 3.24-14.19), lactate (TR 0.80, 95% CI 0.74-0.87), SOFA score (TR 0.84, 95% CI 0.79-0.89), previous radiotherapy (TR 0.53, 95% CI 0.32-0.88), previous medical cancer treatment (TR 0.67, 95% CI 0.42-1.07), bacteremia (TR 2.14, 95% CI 1.25-3.64) and albumin (TR 1.06, 95% CI 1.02-1.10) as independent predictors of 90 day survival. Conclusions: This study of solid tumor patients admitted to ICU is one of the largest to date with the longest follow up period, providing up to date survival data to inform clinicians and patients. Patients with solid tumors and sepsis admitted to ICU have short and medium term survival rates comparable to non-cancer populations and therefore the presence of cancer should not prevent ICU admission. Prior oncological therapies may affect survival in patients admitted to ICU with sepsis.