Ellaithy Ibrahim, Elshiekh Hind, Elshennawy Safia, Elshenawy Sarah, Al-Shaikh Bushra, Ellaithy Asmaa
Faculty of Medicine, Cairo University Kasr Alainy, Cairo, Egypt.
High committee of health specialities, Ministry of Health and population, Egypt.
Ann Med Surg (Lond). 2025 Mar 27;87(4):1838-1845. doi: 10.1097/MS9.0000000000003144. eCollection 2025 Apr.
Sepsis is an aggressive response to an infection leading to widespread inflammation, and may lead to death. It remains a significant challenge for cancer patients especially for the elderly due to their immunocompromised status and other comorbidities. So, this study aimed to assess the risk of mortality due to sepsis among elderly cancer patients and provide an updated evidence to the literature for better management outcomes.
We used data from the Surveillance, Epidemiology, and End Results (SEER) program. We included cancer patients who died due to sepsis between 2000 and 2021. The Standardized Mortality Ratio (SMR) for elderly cancer patients who died due to sepsis was calculated as observed/expected (O/E). We used 95% confidence intervals (CI) and the excess risk (ER) was per 100 000. Significance was achieved at 0.05.
Out of 5 239 194 elderly cancer patients, 18 311 died from sepsis. Men represented 55% and the majority were Caucasians (82%). Death from sepsis along 10+ years of follow-up had a significant SMR with an O/E of 1.32 ( >0.05, 95% CI: 1.30-1.34, ER = 2.56) especially within the first year after cancer diagnosis (O/E = 3.00, >0.05). Gastric cancer had an increased risk for sepsis death in the elderly (O/E = 2.55, < 0.05, 95% CI: 2.28-2.85). Liver and intrahepatic bile cancer had a significant SMR for sepsis (O/E = 5.56, < 0.05, 95% CI: 5.01-6.36). However, it had an insignificant risk for sepsis deaths along 120+ months of follow-up period (O/E = 1.21, 95% CI: 0.25-3.52, ER = 1.73).
Sepsis is a rapid silent killer targeting a vulnerable population. Although it had a declining mortality rate along 10+ years of follow up as the majority die due to other cancer-related and non-cancer-related causes, it still represents a certain threat to elderly cancer patients due to the immunosuppression of cancer treatment regimen and antibiotic resistance. Further studies are encouraged to focus on elderly cancer patients' health care and to intensify infection control measures.
脓毒症是机体对感染的一种强烈反应，可导致全身炎症，甚至可能导致死亡。对于癌症患者，尤其是老年患者而言，由于其免疫功能低下及其他合并症，脓毒症仍然是一个重大挑战。因此，本研究旨在评估老年癌症患者因脓毒症导致的死亡风险，并为文献提供最新证据，以实现更好的治疗效果。
我们使用了监测、流行病学和最终结果（SEER）项目的数据。纳入2000年至2021年间因脓毒症死亡的癌症患者。因脓毒症死亡的老年癌症患者的标准化死亡率（SMR）计算为观察值/预期值（O/E）。我们使用95%置信区间（CI），每10万人的超额风险（ER）。显著性水平设定为0.05。
在5239194名老年癌症患者中，18311人死于脓毒症。男性占55%，大多数为白种人（82%）。随访10年以上因脓毒症死亡的SMR显著，O/E为1.32（P<0.05，95%CI：1.30-1.34，ER=2.56），尤其是在癌症诊断后的第一年内（O/E=3.00，P<0.05）。老年胃癌患者因脓毒症死亡的风险增加（O/E=2.55，P<0.05，95%CI：2.28-2.85）。肝癌和肝内胆管癌因脓毒症的SMR显著（O/E=5.56，P<0.05，95%CI：5.01-6.36）。然而，在随访120个月以上期间，其因脓毒症死亡的风险不显著（O/E=1.21，95%CI：0.25-3.52，ER=1.73）。
脓毒症是一种针对弱势群体的快速隐形杀手。尽管在随访10年以上期间死亡率有所下降，因为大多数人死于其他癌症相关和非癌症相关原因，但由于癌症治疗方案的免疫抑制和抗生素耐药性，它仍然对老年癌症患者构成一定威胁。鼓励进一步研究关注老年癌症患者的医疗保健，并加强感染控制措施。
