P3486 - Outcomes of Gram-Negative Sepsis in Cholangiocarcinoma: A National Inpatient Study From 2018-2021

Barath Prashanth Sivasubramanian, MD¹, Diviya Bharathi Ravikumar, MBBS², Abijha Boban, DO, MBA³, Moyan Sun, DO¹, Jaskaranpreet Kaur, MD, MS⁴, Sheena Bhushan, MD¹, Charles Nash, MD^1
1Northeast Georgia Medical Center, Gainesville, GA; ²ESIC Medical College and Hospital, Chennai, Tamil Nadu, India; ³Northeast Georgia Medical Center, Atlanta, GA; ⁴North Alabama Medical Center, Florence, AL

Introduction: Cholangiocarcinoma (CholangCA) in the United States is 1.26 per 100,000 people/year. Gram-negative Sepsis (GnS) has an annual incidence ranging from 71,000-330,000 patients, with case fatalities as high as 132,000/year. However, the burden of GnS in CholangCA is not well documented. We aimed to identify the impact of GnS in CholangCA, focusing on mortality and palliative care services.

Methods: We conducted a retrospective analysis using the National Inpatient Sample Database (2018-2021). Adults with CholangCA primarily admitted for GnS and E.coli sepsis (EcS) were identified using ICD-10 codes. The results of the GnS cohort were compared with those of all other causes of admission (non-GnS). Analysis was performed using propensity matching and multivariate regression.

Results: Of 19,797 CholangCA admissions, 4.8% (n=959) were admitted for GnS, and 95.1% (n=18,838) were admitted for non-GnS (P< 0.001). The GnS cohort had higher mortality rates than the non-GnS mortality (10.4% vs 7.2%; P< 0.001). However, after controlling for confounders, patients with GnS showed a lower mortality risk than non-GnS (AOR 0.7; P≤0.01). Additionally, we identified key predictors of mortality in GnS. These include age ≥55 years (AOR 0.3; P≤0.05), acute kidney injury (AOR 2.9; P≤0.0001), metabolic encephalopathy (AOR 3.1; P≤0.001), acidosis (AOR 1.9; P≤0.01), acute respiratory failure (AOR 6.4; P≤0.0001), and invasive ventilation (AOR 3.7; P≤0.01). In CholangCA, palliative care was utilized by 19.4% of patients (n=3,841). A crude analysis showed that the proportion of patients with GnS who utilized palliative care was higher than that of non-GnS: 22.7% (n=218) vs 19.2% (n=3,623), P< 0.01. However, after controlling for confounders, GnS patients were less likely to utilize palliative care compared to non-GnS (AOR 0.8; P< 0.05). GnS cohort had higher hospital charges (Coeff $22,039; CI $11,928-$32,151; P< 0.001) and inpatient stays (Coeff 1.6 days; CI 1-2.2 days; P< 0.001) than the non-GnS. In the GnS cohort, 41.9% (n=402) were admitted for EcS, and 10% of these patients (n=40) faced mortality.

Discussion: Our study highlights that Gram-negative sepsis with Cholangiocarcinoma is associated with a lower risk of mortality after adjusting for confounders, despite a higher crude mortality rate compared to all other admissions. Targeted interventions should be implemented to address acute kidney injury, metabolic disturbances, and respiratory failure.


Disclosures:


Barath Prashanth Sivasubramanian, MD¹, Diviya Bharathi Ravikumar, MBBS², Abijha Boban, DO, MBA³, Moyan Sun, DO¹, Jaskaranpreet Kaur, MD, MS⁴, Sheena Bhushan, MD¹, Charles Nash, MD¹. P3486 - Outcomes of Gram-Negative Sepsis in Cholangiocarcinoma: A National Inpatient Study From 2018-2021, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.