Sepsis-related outcomes and the healthcare burden in esophageal cancer patients with atrial fibrillation: A national database study.

Abstract

e16002 Background: Among solid tumors, esophageal cancer (EC) is notably associated with atrial fibrillation (AF). The development of AF in EC is influenced by age-related comorbidities (e.g., hypertension, valvular heart disease), cancer-specific factors such as mechanical compression of the left atrium or pulmonary veins, and treatment-related factors like stent placement, esophagectomy, and chemoradiation. Previous studies have shown that AF in EC is linked to poorer long-term outcomes. However, the impact of AF on in-hospital outcomes in EC patients with sepsis has not been fully investigated. This study explores sepsis-related outcomes and healthcare burden in EC patients with AF, using United States population data. Methods: We identified adult patients with EC hospitalized for sepsis as the principal diagnosis between 2018 and 2021 using ICD-10 codes from the National Inpatient Sample. The cohort was divided by the presence or absence of AF, with complex sampling weights applied to ensure national representation. The primary outcome was all-cause mortality, and several secondary outcomes were also analyzed. Multivariate regression models were used to compare outcomes between groups, with statistical significance set at p < 0.05. Results: We identified 17,670 adults with EC admitted with sepsis between 2018 and 2021. Of these, 4,285 patients (24.3%) had concurrent AF. The overall mortality rate was 21.6%, compared to 24.6% in the AF group. Patients with AF were older (71.8 vs. 66.4 years, p < 0.001), had a higher proportion of males (82.7% vs. 79.2%, p < 0.05), white individuals (84.0% vs. 74.6%, p < 0.001), and Medicare beneficiaries (74.9% vs. 57.9%, p < 0.001). AF was associated with higher odds of all-cause mortality (adjusted odds ratio [aOR] 1.32, 95% CI 1.09–1.60), respiratory failure (aOR 1.37, 95% CI 1.16–1.62), and septic shock (aOR 1.63, 95% CI 1.38–1.93). AF patients also had higher odds of requiring renal replacement therapy (aOR 1.83, 95% CI 1.01–3.30) and mechanical ventilation (aOR 1.79, 95% CI 1.38–2.31). There were no significant differences in the odds of acute kidney injury, ischemic stroke, or vasopressor use. AF was associated with longer hospital stays (8.0 vs. 7.3 days, p < 0.05; adjusted incidence rate ratio [aIRR] 1.12, 95% CI 1.04–1.20) and higher mean hospitalization charges ($107,911 vs. $91,379, p < 0.05; aIRR 1.21, 95% CI 1.10–1.33). Conclusions: Atrial fibrillation in esophageal cancer patients hospitalized for sepsis is associated with higher mortality, increased complications, greater need for intensive care, and higher healthcare resource use. These findings underscore the need for improved management strategies to enhance outcomes and reduce costs in this high-risk population. Future research should investigate the mechanisms linking AF to these adverse outcomes to identify targeted interventions for better patient care.