Epidemiology and outcomes of disseminated intravascular coagulation in pancreatic cancer patients admitted with sepsis: Insights from a national database.

Abstract

e16376 Background: Disseminated intravascular coagulation (DIC) is a coagulopathy involving systemic thrombosis and increased bleeding risk due to consumptive coagulopathy. Pancreatic cancer (PCA) is strongly associated with hypercoagulability and thromboembolic complications. Sepsis, a severe immune response to infection, is common in cancer patients and further predisposes PCA patients to DIC. This study evaluates the epidemiology and outcomes of DIC in PCA patients with sepsis, addressing a critical gap in research. Methods: PCA patients hospitalized with sepsis were identified from the National Inpatient Sample (2019–2021) using ICD-10 codes and stratified by DIC status. Sociodemographic data, comorbidities, and clinical outcomes were analyzed. The primary outcome was all-cause mortality, while secondary outcomes included complications, treatments, length of stay (LOS), and costs. Multivariate regression models were used, with p < 0.05 indicating statistical significance. Results: Among 43,924 PCA patients hospitalized with sepsis, 780 (1.78%) had DIC. DIC patients were younger (65.5 vs. 68.6 years, p = 0.0012), more frequently white (51.7%, p < 0.001), and predominantly treated at teaching hospitals (89.1% vs. 77.5%, p = 0.0005), with higher prevalence in the southern U.S. (36.1%, p = 0.0084). DIC was strongly associated with blood transfusion (26.3% vs. 7.8%, p < 0.001) and liver cirrhosis (8.9% vs. 4%, p = 0.002) but less common in patients receiving chemotherapy (7.05% vs. 13.08%, p = 0.027). Overall mortality was 17.5% but significantly higher in the DIC group (62.2%). DIC patients had higher odds of mortality (aOR 8.02, 95% CI 5.64–11.41) and complications, including acute kidney injury (aOR 4.29, 95% CI 2.94–6.26), respiratory failure (aOR 3.82, 95% CI 2.69–5.44), septic shock (aOR 3.65, 95% CI 2.60–5.11), ischemic stroke (aOR 4.05, 95% CI 1.94–8.47), hemorrhagic stroke (aOR 5.02, 95% CI 1.42–17.71), sudden cardiac death (aOR 3.69, 95% CI 2.04–6.66), deep venous thrombosis (aOR 2.41, 95% CI 1.57–3.72), and acute hepatic failure (aOR 5.69, 95% CI 3.70–8.74). Invasive interventions, such as renal replacement therapy (aOR 2.99, 95% CI 1.51–5.93), mechanical ventilation (aOR 4.79, 95% CI 3.23–7.10), and vasopressors (aOR 2.79, 95% CI 1.73–4.50), were more frequently required. DIC was associated with higher costs ($151,577 vs. $85,578, aIRR 1.41, 95% CI 1.19–1.67), though LOS was comparable (mean 6.69 days). No differences were observed in rates of gastrointestinal hemorrhage, acute anemia, acute heart failure, or pulmonary edema. Conclusions: DIC significantly increases mortality, complications, and costs in pancreatic cancer patients with sepsis, emphasizing the need for tailored management strategies to improve outcomes in this high-risk population.