title: The epidemiology of sepsis in patients with malignancy.
abstract: OBJECTIVE
  To evaluate the longitudinal epidemiology of sepsis in patients with a history of cancer and to specifically examine sepsis-related disparities in risk or outcome.
  
  
  METHODS
  Sepsis cases from 1979 through 2001 using a nationally representative sample of nonfederal acute-care hospitalizations in the United States (the National Hospital Discharge Survey) integrated with cancer prevalence from the Surveillance, Epidemiology, and End Results database.
  
  
  METHODS
  Eight hundred fifty-four million acute-care hospitalizations and 8.9 million patients with cancer.
  
  
  METHODS
  Patients with a history of cancer hospitalized with a diagnosis of sepsis.
  
  
  RESULTS
  From 1979 to 2001, there were a total of 1,781,445 cases of sepsis in patients with cancer, yielding a mean annual incidence rate of 1,465 cases per 100,000 cancer patients and a relative risk [RR] of 9.77 compared to noncancer patients (95% confidence interval [95% CI], 9.67 to 9.88). In contrast to the absolute number of cases, the incidence rate of sepsis decreased over time, from a peak of 1,959 cases per 100,000 cancer patients in 1987 to 995 cases per 100,000 in 2001. The distribution of infectious sources causing sepsis was associated with the type of malignancy. White cancer patients had a lower risk for sepsis compared to nonwhites (African-American RR, 1.28; 95% CI, 1.16 to 1.40) and other races (RR, 1.47; 95% CI, 1.22 to 1.72); and male cancer patients had a higher risk for sepsis compared to female cancer patients (male RR, 1.17; 95% CI, 1.10 to 1.23). Cancer was an independent predictor of death among sepsis patients by multivariable analysis (adjusted odds ratio for death, 1.98; 95% CI, 1.97 to 1.99).
  
  
  CONCLUSIONS
  Patients with a history of cancer are at increased risk for acquiring and subsequently dying from sepsis, compared to the general population, although incidence and fatality rates are decreasing over time. There are significant racial and gender disparities in the incidence and outcome of sepsis among cancer patients that require explanation.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care, Emory University School of Medicine, Atlanta, GA 30303, USA.
authors.forename: Pajman A
authors.initials: PA
authors.lastname: Danai
authors.forename: Marc
authors.initials: M
authors.lastname: Moss
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000473:pathology; D018570:Risk Assessment; D018426:SEER Program; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology; D012737:Sex Factors; D015996:Survival Rate; D014481:United States; D044465:White People / Q000706:statistics & numerical data*