P3627 - Predictors of Mortality in Gastric Cancer and Colon Cancer in Severe Sepsis: A Propensity-Matched Analysis

Deepak Venkataraman, MD¹, Barath Prashanth Sivasubramanian, MD², Viraj Panchal, MBBS³, Abul Hasan Shadali Abdul Khader, MBBS⁴, Diviya Bharathi Ravikumar, MBBS⁵, Sindhu Chandra Pokhriyal, MD⁶, Nithin Prabhakar, MBBS⁷, Jaskaranpreet Kaur, MD, MS⁸, Vikramaditya Samala Venkata, MD^9
1Davao Medical School Foundation Inc., Philippines, Chennai, Tamil Nadu, India; ²Northeast Georgia Medical Center, Gainesville, GA; ³Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India; ⁴Government Kilpauk Medical College, Chennai, Tamil Nadu, India; ⁵ESIC Medical College and Hospital, Chennai, Tamil Nadu, India; ⁶One Brooklyn Health-Interfaith Medical Center, Ozone Park, NY; ⁷Mandya Institute of Medical Sciences, Mandya, Karnataka, India; ⁸North Alabama Medical Center, Florence, AL; ⁹Cheshire Medical Center/Dartmouth-Hitchcock Keene, Keene, NH

Introduction: Up to 48% of solid organ malignancies and 20% of gastrointestinal malignancies (GIM) result in ICU admissions due to severe sepsis (SS). However, there is a paucity of data looking at the determinants of mortality in GIM-SS. Our aim was to identify the predictors of mortality for gastric cancer (GC) and colon cancer (CC) patients admitted for severe sepsis.

Methods: A cross-sectional analysis was conducted using the National Inpatient Sample Database (2018-2021). The ICD-10 codes were used to identify adults with GC and CC having SS (with and without shock). Analysis was done by propensity matching and multivariate regression to reduce confounding.

Results: Of 32,984 GC patients, 2,093 (6.3%) had SS, and the remaining 30,891 (93.7%) were all-cause admissions in GC. Of 135,928 CC patients, 7,774 (5.7%)) had SS and the remaining 128,154 (94.3%)were all-cause admissions in CC. Those having SS were found to have higher mortality in GC (37.4% vs 5.6%) and CC (29.3% vs 5.7%) when compared to those without. SS showed significant (p< 0.001) mortality in GC (aOR 4.5; CI 1.7-12.2) and colonic cancer (aOR 5.1; CI 4.7-5.6). In GC, female gender (aOR 1.4; CI 1.1-1.7; p≤0.05) and acute kidney injury (aOR 2.3; CI 1.9-2.9; p< 0.001) were significant predictors of mortality. In CC, we identified the same factors: female gender (aOR 1.2; CI 1.1-1.3; p< 0.01) and acute kidney injury (aOR 1.7; CI 1.5-1.9; p< 0.001). In both malignancies, respiratory complications such as acute respiratory failure and ARDS and the need for invasive ventilation increased the likelihood of mortality (p≤0.05). The inpatient stays in GC-SS (Coeff 5.4 days; CI 2.4-8.4 days) and CC-SS (Coeff 5.6 days; CI 5.3-5.9 days) were longer than without SS (p< 0.001). The hospital charges were higher in GC-SS (Coeff $105,481; CI $30,323-180,639) and CC-SS (Coeff $97,804; CI $92,038-103,570) than without SS (p< 0.01). On analyzing the causative organism of sepsis in GIM, both GC and CC, the mortality with gram-negative infection in GIM was lower than non-gram-negative infection (25% vs 28%, p=0.9).

Discussion: Among GIM admissions, patients admitted with sepsis have higher mortality compared to all-cause admissions. Female gender, respiratory failure, and acute kidney injury were significantly associated with higher mortality among GIM patients admitted with sepsis. Our study emphasizes the need for tailored management strategies to improve survival.


Disclosures:


Deepak Venkataraman, MD¹, Barath Prashanth Sivasubramanian, MD², Viraj Panchal, MBBS³, Abul Hasan Shadali Abdul Khader, MBBS⁴, Diviya Bharathi Ravikumar, MBBS⁵, Sindhu Chandra Pokhriyal, MD⁶, Nithin Prabhakar, MBBS⁷, Jaskaranpreet Kaur, MD, MS⁸, Vikramaditya Samala Venkata, MD⁹. P3627 - Predictors of Mortality in Gastric Cancer and Colon Cancer in Severe Sepsis: A Propensity-Matched Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.