Colon cancer sidedness in relation to sepsis risk and clinical predictors: A National Inpatient Sample analysis.

Abstract

e15700 Background: Colon cancer patients are at increased risk for developing sepsis during hospitalization. It is unclear if there are differences in risk or clinical predictors of sepsis between right and left-sided colon cancers. Methods: Adult non-elective hospitalizations with colon cancer (ca. colon) were identified from the National Inpatient Sample from 2017 to 2022. Eligible patients were coded with colon cancer (ICD-10: C18.x-C209) and either right or left-sided ca colon. Sepsis was identified by ICD-10 A40–A41. Survey weighted logistic regression was used to assess the association of tumor sidedness on risk of sepsis with adjustment for obstruction, perforation/peritonitis, neutropenia, chronic kidney disease (CKD), cirrhosis, proxies of frailty, colectomy, chemotherapy, weekend admission, demographics. Multiplicative interaction terms were created between sidedness and all predictors of interest to formally assess effect modification. Adjusted marginal probabilities of sepsis by sidedness were also estimated. Results: The weighted study cohort included 301,340 hospitalizations. Patients with left-sided ca. colon had higher adjusted risks of sepsis when compared to right-sided cancers (13.6% vs 11.2%). In multivariable interaction models including sidedness and all predictors of interest, left-sided tumors were associated with higher odds of sepsis compared to right-sided tumors (adjusted odds ratio [aOR] 1.25, 95% CI 1.15–1.35). Perforation/peritonitis (aOR 7.06), neutropenia (aOR 2.83), frailty (aOR 1.98), and CKD (aOR 1.20) were associated with the highest adjusted odds of sepsis overall. Formal tests for effect modification demonstrated statistically significant results for perforation/peritonitis (interaction p-value = 0.003) and colectomy (p-value = 0.017). Neutropenia approached statistical significance (p-value = 0.062). The global test for interaction was statistically significant (p-value = 0.016). Marginal-effects modeling showed large absolute differences in probability of sepsis associated with perforation among both right and left-sided cancers; however effects were modestly higher among right-sided cancers. Conclusions: Hospitalized patients with left-sided ca colon have higher adjusted risk for developing sepsis compared to those with right-sided tumors. Perforation/peritonitis and colectomy were found to have significantly different associations with sepsis by tumor sidedness. Predictor aOR (95% CI) Interaction p-value Right-sided Δ Risk (%) Left-sided Δ Risk (%) Left vs Right sidedness 1.25 (1.15–1.35) Perforation/peritonitis 7.06 (6.48–7.69) 0.003 +30.9 +30.6 Neutropenia 2.83 (2.37–3.38) 0.062 +13.1 +10.9 Frailty proxy 1.98 (1.85–2.12) 0.46 +7.3 +8.1 CKD 1.20 (1.11–1.31) 0.33 +1.7 +2.8 Colectomy proxy 0.66 (0.62–0.71) 0.017 −3.7 −3.0 Δ Risk = absolute change in predicted probability of sepsis from margins.