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Malignancy linked to higher mortality in sepsis, with pooled odds ratios up to 2.41Cancer Diagnosis Impacts Survival Rates for Patients with Sepsis and Septic Shock
Annals of medicinePublished October 31, 2026Study authors: Chung Huei, Chou Hung-Chang, Tsai Tsung-Yu, Chung Ming-ChuPubMed ↗DOI ↗Editorial oversight: Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development
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Key Takeaway
Recognize malignancy as a prognostic factor for higher mortality in sepsis, but note estimates are unadjusted.
This systematic review and meta-analysis synthesized observational data from 105 eligible studies comprising 20,089,138 participants to compare mortality among adults with sepsis or septic shock with and without malignancy. Eighty-five studies contributing 101 endpoint estimates were included in the primary synthesis.
Pooled crude odds ratios were elevated for in-hospital mortality (OR 1.90, 95% CI 1.69-2.13), early mortality (OR 1.81, 95% CI 1.59-2.06), intermediate mortality (OR 2.28, 95% CI 1.72-3.03), and extended follow-up mortality (OR 2.41, 95% CI 1.70-3.42). For ICU mortality, the pooled odds ratio was elevated but the confidence interval crossed the null (OR 1.21, 95% CI 0.94-1.56).
Subgroup analyses showed associations sustained for haematologic malignancy, concentrated in in-hospital and early mortality for metastatic disease, and more modest for solid tumours. Sensitivity analyses were directionally consistent, though risk ratio estimates were generally smaller than odds ratios. Exploratory meta-regression suggested severity-related covariates may contribute to heterogeneity.
The authors note key limitations: primary estimates were unadjusted (crude odds ratios), so results represent overall prognostic associations rather than independent causal effects. Heterogeneity was present, and future studies should incorporate more granular cancer characteristics. Funding and conflicts of interest were not reported.
These findings support endpoint-specific prognostic assessment in adults with sepsis or septic shock and malignancy, but should not be interpreted as evidence of a causal effect of malignancy on mortality.
How this fits prior evidence
This meta-analysis extends prior sepsis coverage by quantifying mortality associations with malignancy, a comorbidity not addressed in earlier items. Where prior coverage examined sivelestat-containing regimens (OR 0.55 for all-cause mortality in sepsis-induced ARDS), THBS1 expression, heparin (no mortality benefit in a 426-patient meta-analysis), and MitoQ in SALI, this review focuses on prognostic stratification rather than a specific therapy. The elevated crude odds ratios for in-hospital, early, intermediate, and extended mortality align with the broader theme that host and disease factors influence sepsis outcomes, while the non-significant ICU mortality estimate (OR 1.21, 95% CI 0.94-1.56) underscores the need for endpoint-specific interpretation.
Doctors looked at over 20 million people to see how having cancer affects survival for patients with sepsis or septic shock. Sepsis is a life-threatening reaction to an infection. The study compared patients with cancer to those without cancer to see if the presence of cancer changed the outcome.
Patients with cancer had a much higher risk of dying in the hospital compared to those without cancer. This risk was also higher during the early stages of treatment and during follow-up periods. The data shows that the presence of a cancer diagnosis is linked to a higher chance of death for these patients.
Different types of cancer showed different patterns. For example, blood cancers and metastatic diseases were linked to higher death rates in the hospital. While the study did not prove that cancer caused these deaths directly, it shows that having a cancer diagnosis is a major factor for doctors to watch.
These findings help doctors better understand the risks for patients with complex health issues. By knowing these risks, medical teams can provide better care and more specific support for patients who have both cancer and a severe infection.
What this means for you:
Patients with cancer have a significantly higher risk of death when they develop sepsis or septic shock.
Common questions
How much higher is the risk of dying from sepsis if you have cancer?
The review found that people with sepsis and cancer had higher odds of death. For in-hospital death, the odds ratio was 1.90, meaning nearly double the odds compared to sepsis patients without cancer. For early death, the odds ratio was 1.81. These are unadjusted estimates, so they don't prove cancer caused the extra deaths.
Does this mean cancer causes more deaths from sepsis?
Not necessarily. The review looked at associations, not cause and effect. The estimates were unadjusted, so other factors like age, overall health, or severity of illness could explain part of the link. The authors say the results show a prognostic association, not a causal one.
Which types of cancer had the strongest link to death in sepsis?
The review found that the association was sustained for blood cancers (haematologic malignancies) and was concentrated in in-hospital and early mortality for metastatic disease. For solid tumours, the link was more modest. However, the review did not provide specific numbers for these subgroups.
Was the increased risk seen in all time periods?
The review looked at different mortality endpoints. The odds of death were significantly higher for in-hospital, early, intermediate, and extended follow-up mortality. However, for ICU mortality, the odds ratio was elevated (1.21) but the confidence interval crossed 1, meaning it was not statistically significant.
BACKGROUND: Sepsis is a major global health challenge and increasingly affects patients with complex conditions such as malignancy. Prior studies suggest higher mortality in this population, but interpretation is limited by aggregation of heterogeneous endpoints. We conducted a systematic review and meta-analysis to clarify endpoint-specific prognostic associations between malignancy and mortality in adults with sepsis or septic shock.
METHODS: This study was registered in PROSPERO (CRD420251141216). PubMed, Embase, Web of Science, Cochrane Library and Epistemonikos were searched through 16 September 2025, for studies comparing all-cause mortality between sepsis patients with and without malignancy. Mortality endpoints were grouped as ICU, in-hospital, early, intermediate and extended follow-up mortality. Crude odds ratios (ORs) were estimated using random-effects meta-analysis. Subgroup, meta-regression and sensitivity analyses were performed to explore heterogeneity and assess consistency.
RESULTS: Among 105 eligible studies comprising 20,089,138 participants, 85 studies contributing 101 endpoint estimates were included in the primary synthesis. Pooled estimates were elevated across endpoints: ICU (OR 1.21, 95% CI 0.94-1.56), in-hospital (OR 1.90, 95% CI 1.69-2.13), early (OR 1.81, 95% CI 1.59-2.06), intermediate (OR 2.28, 95% CI 1.72-3.03) and extended follow-up mortality (OR 2.41, 95% CI 1.70-3.42). Associations were sustained for haematologic malignancy, concentrated in in-hospital and early mortality for metastatic disease and more modest for solid tumours. Sensitivity analyses were directionally consistent, although risk ratio estimates were generally smaller than ORs. Exploratory meta-regression suggested that severity-related covariates may contribute to heterogeneity.
CONCLUSIONS: Malignancy was associated with higher mortality among adults with sepsis or septic shock, with variation across mortality endpoints and clinical contexts. These findings support endpoint-specific prognostic assessment and highlight the need for future studies to incorporate more granular cancer characteristics. Because the primary estimates were unadjusted, results represent overall prognostic associations rather than independent causal effects.
