A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort

doi:10.1016/j.canep.2018.05.001

. 2018 Aug:55:30-38.

doi: 10.1016/j.canep.2018.05.001. Epub 2018 May 25.

A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort

Justin Xavier Moore¹, Tomi Akinyemiju², Alfred Bartolucci³, Henry E Wang⁴, John Waterbor⁵, Russell Griffin⁵

Affiliations

¹ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States; Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, United States. Electronic address: jxmoore@wustl.edu.
² Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States; Department of Epidemiology, University of Kentucky, Lexington, KY, United States.
³ Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States.
⁴ Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States.
⁵ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States.

PMID: 29763753
PMCID: PMC6054880
DOI: 10.1016/j.canep.2018.05.001

A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort

Justin Xavier Moore et al. Cancer Epidemiol. 2018 Aug.

. 2018 Aug:55:30-38.

doi: 10.1016/j.canep.2018.05.001. Epub 2018 May 25.

Authors

Justin Xavier Moore¹, Tomi Akinyemiju², Alfred Bartolucci³, Henry E Wang⁴, John Waterbor⁵, Russell Griffin⁵

Affiliations

¹ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States; Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, St Louis, MO, United States. Electronic address: jxmoore@wustl.edu.
² Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States; Department of Epidemiology, University of Kentucky, Lexington, KY, United States.
³ Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, United States.
⁴ Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX, United States.
⁵ Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States.

PMID: 29763753
PMCID: PMC6054880
DOI: 10.1016/j.canep.2018.05.001

Abstract

Background: Hospitalized cancer patients are nearly 10 times more likely to develop sepsis when compared to patients with no cancer history. We compared the risk of sepsis between cancer survivors and no cancer history participants, and examined whether race was an effect modifier.

Methods: We performed a prospective analysis of data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We categorized participants as "cancer survivors" or "no cancer history" derived from self-reported responses of being diagnosed with any cancer, excluding non-melanoma skin cancer. We defined sepsis as hospitalization for a serious infection with ≥2 systemic inflammatory response syndrome criteria. We performed Cox proportional hazard models to examine the risk of sepsis after cancer (adjusted for sociodemographics, health behaviors, and comorbidities), and stratified by race.

Results: Among 29,693 eligible participants, 2959 (9.97%) were cancer survivors, and 26,734 (90.03%) were no cancer history participants. Among 1393 sepsis events, the risk of sepsis was higher for cancer survivors (adjusted HR: 2.61, 95% CI: 2.29-2.98) when compared to no cancer history participants. Risk of sepsis after cancer survivorship was similar for Black and White participants (p value for race and cancer interaction = 0.63).

Conclusion: In this prospective cohort of community-dwelling adults we observed that cancer survivors had more than a 2.5-fold increased risk of sepsis. Public health efforts should attempt to mitigate sepsis risk by awareness and appropriate treatment (e.g., antibiotic administration) to cancer survivors with suspected infection regardless of the number of years since cancer remission.

Keywords: Cancer survivors; Community-dwelling; Infection; Racial disparities; Sepsis; Survival analysis.

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Conflict of interest statement

CONFLICT OF INTERESTS: The authors declare no potential conflicts of interest.

Figures

**Figure 1**
Flowchart of REGARDS study participants used in study analysis.

**Figure 2**
Kaplan Meier survival curve for time to sepsis event by cancer status.

**Figure 3**
Kaplan Meier survival curve for time to sepsis event by cancer status for each race/ethnicity. Figure in panel A represents the survival for Blacks. Figure in panel B represents the survival for Whites.

See this image and copyright information in PMC

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References

1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Critical Care Medicine. 2001;29:1303–10. - PubMed
1. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. New England Journal of Medicine. 2003;348:1546–54. - PubMed
1. Wang HE, Shapiro NI, Angus DC, Yealy DM. National estimates of severe sepsis in United States emergency departments. Critical Care Medicine. 2007;35:1928–36. - PubMed
1. Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129:1432–40. - PubMed
1. Sammon JD, Klett DE, Sood A, Olugbade K, Schmid M, Kim SP, Menon M, Trinh Q. Sepsis after major cancer surgery. Journal of Surgical Research. 2015;193:788–94. - PubMed

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[1] Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Critical Care Medicine. 2001;29:1303–10. - PubMed

[2] Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Critical Care Medicine. 2001;29:1303–10. - PubMed

[3] Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. New England Journal of Medicine. 2003;348:1546–54. - PubMed

[4] Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. New England Journal of Medicine. 2003;348:1546–54. - PubMed

[5] Wang HE, Shapiro NI, Angus DC, Yealy DM. National estimates of severe sepsis in United States emergency departments. Critical Care Medicine. 2007;35:1928–36. - PubMed

[6] Wang HE, Shapiro NI, Angus DC, Yealy DM. National estimates of severe sepsis in United States emergency departments. Critical Care Medicine. 2007;35:1928–36. - PubMed

[7] Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129:1432–40. - PubMed

[8] Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129:1432–40. - PubMed

[9] Sammon JD, Klett DE, Sood A, Olugbade K, Schmid M, Kim SP, Menon M, Trinh Q. Sepsis after major cancer surgery. Journal of Surgical Research. 2015;193:788–94. - PubMed

[10] Sammon JD, Klett DE, Sood A, Olugbade K, Schmid M, Kim SP, Menon M, Trinh Q. Sepsis after major cancer surgery. Journal of Surgical Research. 2015;193:788–94. - PubMed

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A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort

Affiliations

A prospective study of cancer survivors and risk of sepsis within the REGARDS cohort

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Cited by

References

Publication types

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Grants and funding

LinkOut - more resources

Full Text Sources

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Medical