Mortality in Cancer Patients with Septic Shock in Intensive Care: Systematic Review and Meta-Analysis
María Fernanda García, Yunqi Yu-Liu, Harold Alexander-León, Luis Fuenmayor-González, Carlos Manterola, Támara Otzen, Pablo Llerena, P Granda, Alann David Navas Hidalgo, Nancy Janeth Changoluisa Aimacaña, Brayan Alexander Llumitasig Vaca, Eduardo Velasco, Henry Caballero, Nayely García-Méndez
Abstract
Background The state of prior immunosuppression in cancer enhances harmful effects (eg, sepsis). Despite advances in cancer treatment and sepsis management, the number of critically ill patients with cancer is increasing. Although the overall survival of patients with cancer experiencing septic shock has improved, the mortality observed in studies remains high. Purpose To determine the rate mortality from septic shock in patients with cancer by analyzing variations. Design Systematic review and meta-analysis. Data Sources and Methods A systematic search was performed in Medline, EMBASE, SCOPUS, Web of Science, and BIREME-BVS. Articles assessing mortality in patients with cancer experiencing septic shock (aged >18 years) were included. Review articles, letters to the editor, case reports, and conference proceedings were excluded. Methodological quality was assessed with the MInCir-Prognosis Scale and the Joanna Briggs Institute checklist to assess the risk of bias in prevalence studies. Results Overall mortality rate from septic shock was 58% (95% confidence interval [95%CI]: 54-63). Mortality rate during 2000–2010 and 2010–2024 was 61% (95%CI: 53-68) and 58% (95%CI: 52-63), respectively. Mortality rate by continent was 50% (95%CI: 24-76) in Africa, 61% (95%CI: 53-69) in Asia, 53% (95%CI: 48-59) in Europe, 64% (95%CI: 48-78) in North America, and 61% (95%CI: 37-82) in South America. Mortality rate in the intensive care unit was 53% (95%CI: 50-57). In-hospital mortality rate was 59% (95%CI: 49-68), and 50% (95%CI: 43-57), 61% (95%CI: 40-81), 69% (95%CI: 58-80) at 28–30, 90 and 180 days, respectively. Conclusions Despite advances in oncology and hematology, mortality among patients with cancer experiencing septic shock remains high and increases over time after discharge from the intensive care unit. Registration: PROSPERO [ID: CRD42023472191].