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Abstract

Introduction: Advances in therapeutics have resulted in prolonged life expectancy of patients with cancer. These patients especially ones with metastatic disease have diminished physiological reserve and remain at high risk of sepsis secondary to immunosuppression from both the chemotherapeutic agents used as well as the underlying malignancy. Outcomes of severe sepsis have not been systematically studied in this population. Hypothesis: Patients with metastatic disease and severe sepsis have higher mortality rate and have different discharge destinations in comparison to similar counterparts without metastatic disease. Methods: Using the Nationwide Inpatient Sample (NIS) from 2007 to 2009, patients older than 18 years, discharged with severe sepsis were identified using ICD-9-CM codes as described in literature. The discharge destinations were identified using the NIS variable DISPUB92. Studied outcomes were mortality, length of hospital stay and discharge disposition. We also examined rates of invasive mechanical ventilation, blood transfusion, use of central venous catheters and new dialysis. Results: There were total of 2,544,941 estimated adult discharges with severe sepsis from 2007 to 2009. Of these, 437,093 (17.2%) had a diagnosis of cancer and of these, 33.6% had metastatic disease. The all-cause in-hospital mortality in patients with metastatic disease was significantly higher at 42.2% (p<0.001) when compared with 29.4% in cancer patients and 24.9% in those without cancer. The median hospital length of stay was 11 days (interquartile range [IQR] 5-22 days) while in those without cancer was 9 days (IQR 5-17 days). The utilization of invasive mechanical ventilation, central venous catheters and new dialysis were significantly lower in this group. Of the survivors, 25.4% were discharged to a hospice facility as compared to 6.2% of patients without cancer. Transfer to skilled nursing facility, intermediate care, long term acute care and rehabilitation centers were significantly lower for persons with metastatic disease. Conclusions: Patients with severe sepsis and metastatic disease have significantly higher in-hospital mortality and higher rate of discharge to hospice facilities.