Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care.
BACKGROUND
Infection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels.


METHODS
Data for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140-208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels.


RESULTS
There were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77-2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94-3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of 3.4 billion dollars per year.


CONCLUSIONS
Severe sepsis is a common, deadly, and costly complication in cancer patients.
Williams
Mark D
MD
Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, Indiana, USA. mardwill@lilly.com
Braun
Lee Ann
LA
Cooper
Liesl M
LM
Johnston
Joseph
J
Weiss
Richard V
RV
Qualy
Rebecca L
RL
Linde-Zwirble
Walter
W
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000145:classification / Q000150:complications / Q000191:economics*; D018426:SEER Program; D018805:Sepsis / Q000191:economics* / Q000453:epidemiology* / Q000209:etiology; D017678:Sex Distribution; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology