Identifying Predictors of Mortality in Sepsis Patients with Malignancy: A Retrospective Cohort Study

Leonard Nainggolan, Rido Prama Eled, Ikhwan Rinaldi, Cleopas Martin Rumende, Chyntia Olivia Maurine Jasirwan, Suryo Anggoro Kusumo Wibowo, Robert Sinto, Khie Chen Lie


Background: Sepsis is a major problem that contributes to a high mortality rate. Its mortality is especially high in patients with malignancy. One study reported that sepsis patients with malignancy have a 2.32 times higher risk of mortality compared to patients without malignancy. For this reason, factors that influence mortality in sepsis patients with malignancy become especially important to provide effective and efficient therapy. This study aims to identify factors that influence mortality in sepsis patients with malignancy. Methods: This study is a retrospective cohort study using medical records of sepsis patients with malignancy who were treated at Cipto Mangunkusumo Hospital from 2020 to 2022. A bivariate analysis was carried out and followed by a logistic regression analysis on variables with p-value<0.25 on the bivariate analysis. Results: Among the 350 eligible sepsis subjects with malignancy, there was an 82% mortality rate (287 subjects). Bivariate and multivariate analyses revealed significant associations between mortality and both SOFA score (adjusted Odds Ratio of 5.833, 95%CI 3.214–10.587) and ECOG performance status (adjusted Odds Ratio of 3.490, 95%CI 1.690–7.208). Conclusion: SOFA score and ECOG performance status are significantly associated with sepsis patient mortality in malignancy cases.


Sepsis; malignancy; mortality


Singer M, Clifford S. Deutschman, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA - J Am Med Assoc. 2016;315(8):801–10.

Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock: 2016. Vol. 43. Intensive care medicine. Berlin: Springer Berlin Heidelberg; 2017. p. 304–77.

Massimo Antonelli, Chua A, Du B, Eckmanns T, et al. Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions [Internet]. World Health Organization. 2020. 56 p. Available from:

Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study. Lancet [Internet]. 2020;395(10219):200–11. Available from:

Purba AKR, Mariana N, Aliska G, et al. The burden and costs of sepsis and reimbursement of its treatment in a developing country: An observational study on focal infections in Indonesia. Int J Infect Dis. 2020;96:211–8.

Abou Dagher G, El Khuri C, Chehadeh AAH, et al. Are patients with cancer with sepsis and bacteremia at a higher risk of mortality? A retrospective chart review of patients presenting to a tertiary care center in Lebanon. Br Med J. 2017;7(3):1–8.

Moore JX, Akinyemiju T, Bartolucci A, Wang HE, Waterbor J, Griffin R. Within the REGARDS Cohort. J Cancer Epidemiol. 2018;0805:30–8.

Hajjar LA, Nakamura RE, de Almeida JP, et al. Lactate and base deficit are predictors of mortality in critically ill patients with cancer. Clinics. 2011;66(12):2037–42.

Nørgaard M, Larsson H, Pedersen G, Schønheyder HC, Rothman KJ, Sørensen HT. Short-term mortality of bacteremia in elderly patients with hematological malignancies. Br J Haematol. 2006;132(1):25–31.

Ñamendys-Silva SA, Guevara-García H, Arredondo-Armenta JM, et al. Incidence of high body mass index in critically ill cancer patients. Nutr Hosp [Internet]. 2016;33(4):832–7. Available from:

Shvetsov YB, Ogino MH, Glibetic N, et al. Association of sepsis mortality with specific cancer sites and treatment type: The multiethnic cohort study. J Pers Med. 2021;11:146.

Torres VBL, Azevedo LCP, Silva UVA, et al. Sepsis-associated outcomes in critically ill patients with malignancies. Ann Am Thorac Soc. 2015;12(8):1185–92.

Costa RT, Zampieri FG, Caruso P, Nassar AP. ECOG performance status and acute organ dysfunction influence hospital mortality in critically ill patients with cancer and suspected infection: A retrospective cohort analysis. Rev Bras Ter Intensiva. 2021;33(2):298–303.

Dim G, Rovina N, Patrani M, et al. History of stage I / II solid tumor malignancy impacts considerably on sepsis mortality: a propensity score matching analysis from the Hellenic sepsis study group. 2019;1(20 9):1–9.

Mirouse A, Vigneron C, Llitjos JF, et al. Sepsis and cancer: An interplay of friends and foes. Am J Respir Crit Care Med. 2020;202(12):1625–35.

Xiang MJ, Chen GL. Impact of cancer on mortality rates in patients with sepsis: A meta-analysis and meta-regression of current studies. World J Clin Cases. 2022;10(21):7386–96.

Greenberg JA, David MZ, Churpek MM, Pitrak DL, Hall JB, Kress JP. Sequential organ failure assessment score modified for recent infection in patients with hematologic malignant tumors and severe sepsis. Am J Crit Care. 2016;25(5):409–17.

Iskandar A, Siska F. Analisis hubungan sequential organ failure assessment (Sofa) score dengan mortalitas pasien sepsis. Jurnal Kesehatan Andalas. 2020;9(2):168–73.

Kementrian Kesehatan R. Beban kanker di Indonesia. Pus Data Dan Inf Kesehat Kementeri Kesehat RI. 2019;1–16.

Nathan N, Sculier JP, Ameye L, Paesmans M, Bogdan-Dragos G, Meert AP. Sepsis and septic shock definitions in patients with cancer admitted in ICU. J Intensive Care Med. 2021;36(3):255–61.

Grissom CK, Brown SM, Kuttler KG, et al. A modified sequential organ failure assessment score for critical care triage. Disaster Med Public Health Prep. 2010;4(4):277–84.

Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: A prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer Part A. 1996;32(7):1135–41.

Portland Health Care System. My chemotherapy treatment. US Dep Veterans Aff. 2017.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.