与脓毒症或脓毒性休克成人患者中恶性肿瘤相关的特定终点死亡率：一项系统综述与荟萃分析。
完整摘要 · 中文译文
背景：脓毒症是全球重大健康挑战，且日益影响恶性肿瘤等复杂疾病患者。既往研究提示该人群死亡率更高，但异质性终点的合并限制了结果的解读。我们开展了一项系统评价与meta分析，以明确成人脓毒症或脓毒性休克患者中恶性肿瘤与死亡率之间特定终点的预后关联。方法：本研究已在PROSPERO注册（CRD420251141216）。检索PubMed、Embase、Web of Science、Cochrane Library和Epistemonikos截至2025年9月16日，纳入比较合并与不合并恶性肿瘤的脓毒症患者全因死亡率的研究。死亡终点分为ICU、住院、早期、中期和延长随访死亡率。采用随机效应meta分析估计粗比值比（OR）。进行亚组、meta回归和敏感性分析以探讨异质性并评估一致性。结果：在纳入的105项研究、共20,089,138名参与者中，85项研究贡献101个终点估计值纳入主要合并分析。各终点的合并估计值均升高：ICU（OR 1.21，95% CI 0.94-1.56）、住院（OR 1.90，95% CI 1.69-2.13）、早期（OR 1.81，95% CI 1.59-2.06）、中期（OR 2.28，95% CI 1.72-3.03）和延长随访死亡率（OR 2.41，95% CI 1.70-3.42）。血液系统恶性肿瘤的关联持续存在，转移性疾病集中于住院和早期死亡率，实体瘤则较为温和。敏感性 分析在方向上是 一致的，尽管风险比估计值通常小于OR值。探索性meta回归提示，严重程度相关协变量可能促成异质性。 结论：恶性肿瘤与脓毒症或脓毒性休克成人患者较高的死亡率相关，且在不同死亡终点和临床背景之间存在差异。这些发现支持针对特定终点的预后评估，并强调未来研究需要纳入更细化的癌症特征。由于主要估计值未经校正，结果代表的是总体预后关联，而非独立的因果效应。 恶性肿瘤始终与脓毒症或脓毒性休克成人患者较高的死亡率相关，汇总OR值从ICU死亡率的1.21到延长随访死亡率的2.41不等。亚型分析提示，在可用的各终点上，血液系统恶性肿瘤较实体瘤呈现更为持续的模式。针对特定终点的评估可通过按所评估的结局时间范围区分死亡关联，从而改善预后解读。
完整摘要 · 英文原文
BACKGROUND: Sepsis is a major global health challenge and increasingly affects patients with complex conditions such as malignancy. Prior studies suggest higher mortality in this population, but interpretation is limited by aggregation of heterogeneous endpoints. We conducted a systematic review and meta-analysis to clarify endpoint-specific prognostic associations between malignancy and mortality in adults with sepsis or septic shock. METHODS: This study was registered in PROSPERO (CRD420251141216). PubMed, Embase, Web of Science, Cochrane Library and Epistemonikos were searched through 16 September 2025, for studies comparing all-cause mortality between sepsis patients with and without malignancy. Mortality endpoints were grouped as ICU, in-hospital, early, intermediate and extended follow-up mortality. Crude odds ratios (ORs) were estimated using random-effects meta-analysis. Subgroup, meta-regression and sensitivity analyses were performed to explore heterogeneity and assess consistency. RESULTS: Among 105 eligible studies comprising 20,089,138 participants, 85 studies contributing 101 endpoint estimates were included in the primary synthesis. Pooled estimates were elevated across endpoints: ICU (OR 1.21, 95% CI 0.94-1.56), in-hospital (OR 1.90, 95% CI 1.69-2.13), early (OR 1.81, 95% CI 1.59-2.06), intermediate (OR 2.28, 95% CI 1.72-3.03) and extended follow-up mortality (OR 2.41, 95% CI 1.70-3.42). Associations were sustained for haematologic malignancy, concentrated in in-hospital and early mortality for metastatic disease and more modest for solid tumours. Sensitivity analyses were directionally consistent, although risk ratio estimates were generally smaller than ORs. Exploratory meta-regression suggested that severity-related covariates may contribute to heterogeneity. CONCLUSIONS: Malignancy was associated with higher mortality among adults with sepsis or septic shock, with variation across mortality endpoints and clinical contexts. These findings support endpoint-specific prognostic assessment and highlight the need for future studies to incorporate more granular cancer characteristics. Because the primary estimates were unadjusted, results represent overall prognostic associations rather than independent causal effects. Malignancy was consistently associated with higher mortality among adults with sepsis or septic shock, with pooled ORs ranging from 1.21 for ICU mortality to 2.41 for extended follow-up mortality.Subtype analyses suggested a more sustained pattern for haematologic malignancy than for solid tumours across available endpoints.Endpoint-specific assessment may improve prognostic interpretation by distinguishing mortality associations according to the outcome timeframe assessed.