Sepsis occurs in 12–27% of patients with haematological malignancy within a year of diagnosis. Sepsis mortality has improved in non-cancer patients in the last two decades, but longitudinal trends in patients with haematological malignancy are not well characterised. We aimed to compare outcomes, including temporal changes, in patients with and without a haematological malignancy admitted to ICU with a primary diagnosis of sepsis in Australia and New Zealand over the past two decades. We performed a retrospective cohort study of 282,627 patients with a primary intensive care unit (ICU) admission diagnosis of sepsis including 17,313 patients with haematological malignancy, admitted to 216 intensive care units (ICUs) in Australia or New Zealand between January 2000 and December 2022. Annual crude and adjusted in-hospital mortality were reported. Risk factors for in-hospital mortality were determined using a mixed methods logistic regression model and were used to calculate annual changes in mortality. In-hospital sepsis mortality decreased in patients with haematological malignancy, from 55.6% (95% CI 46.5–64.6%) in 2000 to 23.1% (95% CI 20.8–25.5%) in 2021. In patients without haematological malignancy mortality decreased from 33.1% (95% CI 31.3–35.1%) to 14.4% (95% CI 13.8–14.8%). This decrease remained significant after adjusting for mortality predictors including age, SOFA score and comorbidities, as estimated by adjusted annual odds of in-hospital death. The reduction in odds of death was of greater magnitude in patients with haematological malignancy than those without (OR 0.954, 95% CI 0.947–0.961 vs. OR 0.968, 95% CI 0.966–0.971, p < 0.001). However, absolute risk of in-hospital mortality remained higher in patients with haematological malignancy. Older age, higher SOFA score, presence of comorbidities, and mechanical ventilation were associated with increased mortality. Leukopenia (white cell count < 1.0 × 109 cells/L) was not associated with increased mortality in patients with haematological malignancy (p = 0.60). Sepsis mortality has improved in patients with haematological malignancy admitted to ICU. However, mortality remains higher in patients with haematological malignancy than those without. Among patients with haematological malignancy and sepsis admitted to intensive care, mortality has fallen by over 50% in the last two decades. Improvements are independent of organ failure, neutropenia, and age; however, mortality remains higher than for patients with no malignancy.

中文翻译：

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2000-2022 年入住重症监护室的血液系统恶性肿瘤患者脓毒症死亡率：一项两国队列研究

12-27% 的血液系统恶性肿瘤患者在诊断后一年内会出现脓毒症。过去二十年来，非癌症患者的脓毒症死亡率有所改善，但血液系统恶性肿瘤患者的纵向趋势尚不清楚。我们的目的是比较过去二十年来澳大利亚和新西兰入住 ICU 的患有和不患有血液恶性肿瘤并初步诊断为败血症的患者的结果，包括时间变化。我们对 2000 年 1 月至 2022 年 12 月期间入住澳大利亚或新西兰 216 个重症监护病房 (ICU) 的 282,627 名初级重症监护病房 (ICU) 入院诊断为脓毒症的患者进行了一项回顾性队列研究，其中包括 17,313 名血液恶性肿瘤患者。报告了年度粗略和调整后的院内死亡率。使用混合方法逻辑回归模型确定院内死亡的危险因素，并用于计算死亡率的年度变化。血液系统恶性肿瘤患者的院内脓毒症死亡率从 2000 年的 55.6% (95% CI 46.5–64.6%) 下降到 2021 年的 23.1% (95% CI 20.8–25.5%)。在没有血液系统恶性肿瘤的患者中，死亡率从 33.1% 下降%（95% CI 31.3–35.1%）至 14.4%（95% CI 13.8–14.8%）。根据调整后的年度院内死亡几率估计，在调整包括年龄、SOFA 评分和合并症在内的死亡率预测因素后，这种下降仍然显着。患有血液系统恶性肿瘤的患者死亡几率的降低幅度大于未患有血液系统恶性肿瘤的患者（OR 0.954，95% CI 0.947–0.961 vs. OR 0.968，95% CI 0.966–0.971，p < 0.001）。然而，血液系统恶性肿瘤患者的院内死亡绝对风险仍然较高。年龄较大、SOFA 评分较高、存在合并症和机械通​​气与死亡率增加相关。白细胞减少症（白细胞计数 < 1.0 × 109 个细胞/L）与血液恶性肿瘤患者死亡率增加无关（p = 0.60）。入住 ICU 的血液系统恶性肿瘤患者的脓毒症死亡率有所改善。然而，患有血液系统恶性肿瘤的患者的死亡率仍然高于未患有血液系统恶性肿瘤的患者。在接受重症监护的血液系统恶性肿瘤和脓毒症患者中，死亡率在过去二十年中下降了 50% 以上。改善与器官衰竭、中性粒细胞减少和年龄无关；然而，死亡率仍然高于非恶性肿瘤患者。