Sepsis and Septic Shock in Cancer Patients

  • Imrana MalikEmail author
  • Joseph L. Nates
Reference work entry


Cancer is one of the most common comorbid medical conditions present among sepsis patients. Although sepsis-related mortality rates in cancer patients are decreasing over time, similar to the general population, their incidence and mortality rates still remain unacceptably high. Because of their underlying cancer diagnoses and immunologic states, cancer patients require special attention and have unique considerations for the treatment and management of sepsis. In addition, new and emerging cancer therapeutics bring additional challenges in the management of sepsis in cancer patients. This chapter begins with a discussion regarding the current dynamics related to sepsis terminology and then covers the prevailing understanding of sepsis epidemiology, etiology, and pathophysiology. Finally, the clinical aspects of diagnosis, management, and prognosis are presented, which are largely based on studies in the general population and have been extrapolated for the cancer patient.


Sepsis Cancer Septic shock SIRS qSOFA 


  1. 1.
    Angus DC, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.CrossRefGoogle Scholar
  2. 2.
    Angus DC, et al. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS and ProMISe investigators. Intensive Care Med. 2015;41:1549–60.CrossRefGoogle Scholar
  3. 3.
    Asfar P, et al. High versus low blood-pressure target in patients with septic shock. NEJM. 2014;370:1583–93.CrossRefGoogle Scholar
  4. 4.
    Azoulay E, et al. Dexamethasone in patients with acute lung injury from acute monocytic leukaemia. Eur Respir J. 2012;39(3):648–53.CrossRefGoogle Scholar
  5. 5.
    Bone RC, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):644–55.Google Scholar
  6. 6.
    Bone RC, et al. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest. 1997;112:235–43.CrossRefGoogle Scholar
  7. 7.
    Carniero AH, Povoa P, Gomes JA. Dear Sepsis-3, we are sorry to say that we don’t like you. Rev Bras Ter Intensiva. 2017;29(1):4–8.Google Scholar
  8. 8.
    Chan T, Gu F. Early diagnosis of sepsis using serum biomarkers. Expert Rev Mol Diagn. 2011;11(5):487–96.CrossRefGoogle Scholar
  9. 9.
    Danai PA, et al. The epidemiology of sepsis in patients with malignancy. Chest. 2006;129(6):1432–40.CrossRefGoogle Scholar
  10. 10.
    De Backer D, et al. Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence. 2014;5(1):73–9.CrossRefGoogle Scholar
  11. 11.
    Dellinger RP, et al. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med. 2004;32(3):858–73.CrossRefGoogle Scholar
  12. 12.
    Fox AC, et al. Cancer causes increased mortality and is associated with altered apoptosis in murine sepsis. Crit Care Med. 2010;38(3):886–93.CrossRefGoogle Scholar
  13. 13.
    Freifeld AG, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010;52(4):e56–93.CrossRefGoogle Scholar
  14. 14.
    Gu WJ, et al. The effect of goal-directed therapy on mortality in patients with sepsis – earlier is better: a meta-analysis of randomized controlled trials. Crit Care. 2014;18(5):570.CrossRefGoogle Scholar
  15. 15.
    Gu WJ, Zhang Z, Bakker J. Early lactate clearance-guided therapy in patients with sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials. Intensive Care Med. 2015;41(10):1862–3.CrossRefGoogle Scholar
  16. 16.
    Henriquez-Camacho C, Losa J. Biomarkers for sepsis. Biomed Res Int. 2014;2014:547818. 6 pages.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Holland T, Fowler VG, Shelburne SA. Invasive gram-positive bacterial infection in cancer patients. Clin Infect Dis. 2014;59(5):S331–4.CrossRefGoogle Scholar
  18. 18.
    Hotchkiss RS, Karl IE. The pathophysiology and treatment of sepsis. N Engl J Med. 2003;348(2):138–50.CrossRefGoogle Scholar
  19. 19.
    Larché J, et al. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med. 2003;29(10):1688–95.CrossRefGoogle Scholar
  20. 20.
    Legrand M, et al. Survival in neutropenic patients with severe sepsis or septic shock. Crit Care Med. 2012;40:43–9.CrossRefGoogle Scholar
  21. 21.
    Levy MM, et al. The surviving sepsis campaign bundle: 2018 update. Crit Care Med. 2018;46(6):997–1000.CrossRefGoogle Scholar
  22. 22.
    Machado FR, et al. Sepsis 3 from the perspective of clinicians and quality improvement initiatives. J Crit Care. 2017;40:315–7.CrossRefGoogle Scholar
  23. 23.
    Maheshwari K, et al. The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Intensive Care Med. 2018; [Epub ahead of print]. PMID: 29872882.
  24. 24.
    Malik I, et al. Sepsis and acute myeloid leukemia: a population-level study of comparative outcomes of patients discharged from Texas hospitals. Clin Lymphoma Myeloma Leuk. 2017;17(12):e27–32.CrossRefGoogle Scholar
  25. 25.
    Mancini N, Clerici D, Diotti R, et al. Molecular diagnosis of sepsis in neutropenic patients with haematological malignancies. J Med Microbiol. 2008;57(5):601–4.Google Scholar
  26. 26.
    Martin GS, et al. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–54.CrossRefGoogle Scholar
  27. 27.
    Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis. Crit Care Med. 2006;34:15–21.CrossRefGoogle Scholar
  28. 28.
    Medam S, et al. Risk factors for death in septic shock: a retrospective cohort study comparing trauma and non-trauma patients. Medicine. 2017;96(50):e9241.CrossRefGoogle Scholar
  29. 29.
    Nazer L, et al. Evaluating the effectiveness and safety of hydrocortisone therapy in cancer patients with septic shock. J Oncol Pharm. 2015;21(4):274–9.CrossRefGoogle Scholar
  30. 30.
    Péne F, et al. Temporal changes in management and outcome of septic shock in patients with malignancies in the intensive care unit. Crit Care Med. 2008;36:690–6.CrossRefGoogle Scholar
  31. 31.
    Reinhart K, Meisner M, Brunkhorst FM. Markers for sepsis diagnosis: what is useful? Crit Care Clin. 2006;22(3):503–19.CrossRefGoogle Scholar
  32. 32.
    Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43:304.CrossRefGoogle Scholar
  33. 33.
    Rosolem MM, Rabello LS, Lisboa T, et al. Critically ill patients with cancer and sepsis: clinical course and prognostic factors. J Crit Care. 2012;27(3):301–7.Google Scholar
  34. 34.
    Safdar A, Rolston KV. Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis. 2007;45(12):1602–9.CrossRefGoogle Scholar
  35. 35.
    Safdar A, Armstrong D. Infectious morbidity in critically ill patients with cancer. Crit Care Clin. 2001;17:531–70.CrossRefGoogle Scholar
  36. 36.
    Seymour CW, et al. Assessment of clinical criteria for sepsis for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):762–74.CrossRefGoogle Scholar
  37. 37.
    Singer M, et al. The Third International Consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.CrossRefGoogle Scholar
  38. 38.
    Song JE, et al. Mortality risk factors for patients with septic shock after implementation of the surviving sepsis campaign bundles. Infect Chemother. 2016;48(3):199–208.CrossRefGoogle Scholar
  39. 39.
    Taccone FS, et al. Characteristics and outcomes of cancer patients in European ICUs. Crit Care. 2009;13:R15.CrossRefGoogle Scholar
  40. 40.
    van der Poll T, Opal SM. Host-pathogen interactions in sepsis. Lancet Infect Dis. 2008;8(1):32–43.CrossRefGoogle Scholar
  41. 41.
    Vincent J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323–9.CrossRefGoogle Scholar
  42. 42.
    Wallace SK, et al. Two decades of ICU utilization and hospital outcomes in a comprehensive cancer center. Crit Care Med. 2016;44(5):926–33.CrossRefGoogle Scholar
  43. 43.
    Williams MD, et al. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. Crit Care. 2004;8(5):R291–8.CrossRefGoogle Scholar
  44. 44.
    Xia R, Wang D. Intensive care unit prognostic factors in critically ill patients with advanced solid tumors: a 3-year retrospective study. BMC Cancer. 2016;16:188.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Critical CareThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Critical Care and Respiratory CareThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations