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Open Access Research

Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care

Mark D Williams1*, Lee Ann Braun2, Liesl M Cooper3, Joseph Johnston4, Richard V Weiss5, Rebecca L Qualy6 and Walter Linde-Zwirble7

Author Affiliations

1 Senior Clinical Research Physician, Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, Indiana, USA

2 Senior Clinical Development Associate, Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, Indiana, USA

3 Manager Outcomes Research, Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, Indiana, USA

4 Clinical Research Physician, Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, Indiana, USA

5 Statistician, Health Process Management, Limited Liability Company, Doylestown, Pennsylvania, USA

6 Senior Scientific Communication Associate, Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, Indiana, USA

7 Vice President, Research & Analytical Services, Health Process Management, Limited Liability Company, Doylestown, Pennsylvania, USA

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Critical Care 2004, 8:R291-R298  doi:10.1186/cc2893

Published: 5 July 2004

Abstract

Introduction

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 per year.

Conclusion

Severe sepsis is a common, deadly, and costly complication in cancer patients.

Keywords:
cancer; costs; infection; mortality; severe sepsis