S2847 The Impact of Ischemic Hepatitis on Outcomes and Healthcare Resources Utilization in Patients With Sepsis

Introduction: Sepsis is a clinical syndrome characterized by a dysregulated systemic immune response to infection, leading to end-organ dysfunction. Sepsis remains to be a leading cause of in-hospital mortality worldwide, relaying a significant burden on the healthcare system. Liver hypoperfusion in the setting of sepsis leads to Ischemic hepatitis. Accordingly, we are evaluating IH as a potential predictor of sepsis outcomes. Methods: The National Inpatient Sample (NIS) from 2016 to 2020 was retrospectively queried using International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM)/PCS codes to identify patients discharged with a diagnosis of sepsis and concomitant ischemic hepatitis (IH). The primary outcome was in-hospital mortality. Secondary outcomes included rate of post-procedural complications such as acute kidney injury (AKI), shock, encephalopathy, and sepsis. Length of stay (LOS), total hospital charges and hospital cost were calculated. Moreover, multivariate logistic regression analysis was performed to adjust for potential confounders. Results: A total of 2,790,624 patients who were discharged after hospitalization for sepsis were included in the analysis. Patients were categorized into 2 groups based on the presence of IH. Among these patients, 1,240 (0.0004%) were identified to have IH. These patients were less likely to be White (62.4% vs 55.7%; P = 0.02). Mean age of diagnosis was lower among those with ischemic hepatitis (55.9 vs 62.9; P < 0.01) which explains the predominance of Medicare insurance in both groups (45.6% and 58.0%; P < 0.01). Patients with ischemic hepatitis had higher rate of severe malnutrition (22.9% Vs 9.9%; P < 0.01), CKD stage V (14.1% vs 10.2%; P = 0.05) and cirrhosis, both compensated (5.6% vs 2.4%; P < 0.01) and decompensated (10.9% vs 1.9%; P < 0.01). Among patients with IH, predictors of mortality were SIRS (HR 12.93; P < 0.01), decompensated cirrhosis (HR 1.97; P < 0.01), AKI (HR 2.10; P < 0.01) and age over 65 years (HR 3.81; P < 0.01). On multivariate analysis, there was increased in-hospital mortality (aOR 3.44; P < 0.01) or in the length of stay (15.99 days; P <0.01) and healthcare cost (578,646 US$; P < 0.01). IH had higher odds of ICU admissions (aOR 4.66; P < 0.01), shock (aOR 2.34; P < 0.01), AKI (aOR 2.43; P < 0.01) and pleural effusion (aOR 3.24; P < 0.01). Conclusion: Sepsis with concomitant IH is associated with significantly higher in-hospital mortality, complications, length of stay and healthcare cost. Patients with IH have higher rates of comorbidities including liver cirrhosis.