Sepsis severity and inpatient outcomes in metastatic cancer: A National Inpatient Sample study.

Abstract

11197 Background: Sepsis is a major driver of acute decompensation and inpatient death in patients with cancer, with particularly poor outcomes reported among severe sepsis and septic shock. We evaluated national associations between sepsis severity and inpatient outcomes among metastatic cancer hospitalizations. Methods: We conducted a retrospective cross-sectional analysis of the National Inpatient Sample (2016–2020). Adult hospitalizations with metastatic cancer were identified using ICD-10-CM codes C77–C79. Sepsis severity was categorized as no sepsis, severe sepsis without shock, or septic shock using ICD-10 diagnosis codes. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aOR) for in-hospital mortality, mechanical ventilation, and ICU utilization. Survey-weighted linear regression estimated adjusted differences in length of stay (LOS) and total charges. Models adjusted for age group, sex, race/ethnicity, primary payer, hospital bed size, hospital region, and comorbidity burden using vwcheck (van Walraven score derived from Elixhauser comorbidities). Results: In the complete-case regression cohort (weighted N=1,011,365), severe sepsis was associated with higher in-hospital mortality versus no sepsis (aOR 1.49, 95% CI 1.44–1.54), and septic shock with markedly higher mortality (aOR 4.75, 95% CI 4.63–4.87). Sepsis severity strongly predicted escalation of care: mechanical ventilation (severe sepsis aOR 1.37, 95% CI 1.24–1.50; septic shock aOR 6.31, 95% CI 5.93–6.71) and ICU utilization (severe sepsis aOR 1.07, 95% CI 1.03–1.11; septic shock aOR 6.44, 95% CI 6.26–6.62). Relative to the Northeast, adjusted mortality odds were lower in the Midwest (aOR 0.72), South (aOR 0.77), and West (aOR 0.81). Septic shock was associated with higher resource use (+1.38 LOS days; +$56,975 charges). Conclusions: In hospitalized patients with metastatic cancer, increasing sepsis severity was independently associated with stepwise increases in mortality, need for ICU-level care, and healthcare utilization. Patients with septic shock represented a particularly high-risk subgroup, with markedly elevated mortality and resource use even after adjustment for comorbidity burden. These findings emphasize that sepsis, rather than malignancy alone, is a major driver of inpatient outcomes in advanced cancer and highlight the importance of early recognition and timely escalation of supportive care for this vulnerable population. Association of sepsis severity with inpatient outcomes among metastatic cancer hospitalizations (NIS 2016–2020). Outcome Severe sepsis (aOR or Δ, 95% CI) Septic shock (aOR or Δ, 95% CI) In-hospital mortality 1.49 (1.44–1.54) 4.75 (4.63–4.87) Mechanical ventilation 1.37 (1.24–1.50) 6.31 (5.93–6.71) ICU utilization 1.07 (1.03–1.11) 6.44 (6.26–6.62) Length of stay, days −0.42 +1.38 Total hospital charges, $ −3,325 +56,975