Short-term mortality in elderly sepsis patients with malignant tumors in the intensive care unit
Objective To investigate whether malignant tumors are an independent risk factor for short-term mortality in elderly patients with sepsis in the intensive care unit(ICU),and to examine the dose-response relationship between the sequential organ failure assessment(SOFA)score and short-term mortality in this patient population.Methods A retrospective analysis was conducted on elderly sepsis patients aged 80 and above from the Medical Information Mart for Intensive Care(MIMIC-Ⅳ)database spanning from 2008 to 2019.The patients were categorized into a tumor group and a non-tumor group based on the presence of malignant tumors,and a comparison was made between the baseline data and prognosis of these two groups.Furthermore,patients were classified into survival and mortality groups based on their ICU survival status within 28 days,and a comparison of baseline data was performed.Logistic regression analysis was employed to identify the risk factors associated with short-term mortality.Additionally,probability unit regression was utilized to model the dose-response relationship between the SOFA score and short-term mortality.Results A total of 53 150 medical records were screened,identifying 5 126 elderly sepsis patients aged 80 and above.Among them,754 had malignant tumors and 264 had metastatic tumors.The 28-day mortality rate in the tumor group was significantly higher than in the non-tumor group[26.79％(202/754)vs.18.85％(824/4 372),x2=24.85,P＜0.001].Logistic regression analysis revealed age(OR=1.073,95％CI:1.040-1.108,P＜0.001),Charlson comorbidity index(CCI)excluding tumors(OR=1.134,95％CI:1.067-1.205,P＜0.001),blood lactate concentration at ICU admission(OR=1.111,95％CI:1.048-1.179,P＜0.001),mechanical ventilation(OR=1.603,95％CI:1.176-2.187,P=0.003),and SOFA score(OR=1.227,95％CI:1.182-1.273,P＜0.001)as risk factors for short-term mortality.Conversely,CCI(OR=0.957,95％CI:0.867-1.057,P=0.380),use of vasoactive drugs(OR=1.370,95％CI:0.902-2.081,P=0.140),malignant tumors(OR-1.131,95％CI:0.449-2.848,P=0.794),and metastasis of malignant tumors(OR=1.799,95％CI:0.930-3.477,P=0.081)were not associated with short-term mortality.The dose-response curve illustrated that as the SOFA score increased,patients'28-day mortality rate also rose,reaching 50％at a SOFA score of 11 and exceeding 80％at a score of 20.Conclusions Malignant tumors and tumor metastasis do not appear to be independent risk factors for short-term mortality in elderly sepsis patients in the ICU.Instead,the short-term mortality rate of these patients seems to be correlated with the SOFA score in a dose-response manner.
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