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. 2023 Feb;88(2):329-337.
doi: 10.1016/j.jaad.2022.10.029. Epub 2022 Oct 17.

Retrospective analysis of sepsis in cutaneous T-cell lymphoma reveals significantly greater risk in Black patients

Madeline J Hooper  1 , Francesca L Veon  1 , Gail L Enriquez  2 , Morgan Nguyen  1 , Cameron B Grimes  1 , Tessa M LeWitt  1 , Yanzhen Pang  1 , Slaton Case  1 , Jaehyuk Choi  1 , Joan Guitart  1 , Michael B Burns  2 , Xiaolong A Zhou  3
Affiliations

Retrospective analysis of sepsis in cutaneous T-cell lymphoma reveals significantly greater risk in Black patients

Madeline J Hooper et al. J Am Acad Dermatol. 2023 Feb.

Abstract

Background: Sepsis is a leading cause of morbidity, mortality, and resource utilization among patients with cutaneous T-cell lymphoma (CTCL).

Objective: To characterize the demographic, clinical, and microbial attributes distinguishing patients with CTCL sepsis from other patients with non-Hodgkin lymphoma (NHL) sepsis and patients with CTCL in general.

Methods: Two-part retrospective cohort study at an academic medical center from 2001-2019 involving patients with CTCL (n = 97) and non-CTCL NHL (n = 88) admitted with sepsis, and a same-institution CTCL patient database (n = 1094). Overall survival was estimated by Kaplan-Meier analyses.

Results: Patients with CTCL sepsis were more likely to be older, Black, experience more sepsis episodes, die or be readmitted within 30 days of an inpatient sepsis episode, and develop Gram-positive bacteremia than patients with non-CTCL NHL sepsis. Staphylococcus aureus and Escherichia coli were the most frequently speciated organisms in CTCL (26%) and non-CTCL NHL (14%), respectively. No between-group differences were identified regarding sex, presence of central line, chemotherapy use, or disease stage. Compared with general patients with CTCL, patients with sepsis were Black and exhibited advanced-stage disease, higher body surface area involvement, and higher lactate dehydrogenase levels.

Limitations: Single institution, retrospective nature may limit generalizability.

Conclusion: Awareness of CTCL-specific risk factors is crucial for guiding sepsis prevention and improving patient outcomes.

Keywords: Black patients; bacteremia; cutaneous T-cell lymphoma; non-Hodgkin lymphoma; outcomes; race; risk factors; sepsis.

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Conflict of interest statement

Conflicts of interest Dr Zhou was supported by a career development award from the Dermatology Foundation, a Cutaneous Lymphoma Foundation Catalyst Research Grant, and an institutional grant from Northwestern University Clinical and Translational Sciences Institute and National Institute of Health (Grant # 5KL2TR001424). Mss Hooper, Veon, Enriquez, Grimes, Pang, Mr Case, and Drs LeWitt, Nguyen, Choi, Guitart, and Burns have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Kaplan-Meier estimates of overall survival amongst CTCL (n=97) and non-CTCL NHL (n=88) patients who developed sepsis for Staphylococcus versus non-Staphylococcus bacteremia; Gram-negative versus Gram-positive bacteremia; blood microbe type (bacterial, viral, fungal); and history of stem cell transplant. Adjusted p-values (q-values) were calculated using false discovery rate (FDR) correction of 0.05.
Figure 2.
Figure 2.
Demographic and clinical characteristics differentiate CTCL sepsis (n=97), non-CTCL NHL sepsis (n=88), and general CTCL (n=1094) cohorts. (a) Comparison of general CTCL and CTCL sepsis cohorts at first presentation and first sepsis episode, respectively, revealed lactate dehydrogenase (LDH) levels and percentage of body surface area of disease involvement trended higher within the sepsis cohort. Dot plot demonstrates LDH values normalized to the upper limit of normal (i.e., 271 units/L at Northwestern). Red horizontal bar signifies group median. (b) Analysis of cohort racial composition demonstrated a larger percentage of the CTCL sepsis group was Black compared to both the non-CTCL NHL and general CTCL groups. Combined analysis of both clinical stage and race revealed a significant proportion of Black patients have advanced-stage disease within the general CTCL cohort; however, no significant difference existed between Black and White sepsis patients based on disease stage distribution.
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References

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