S2775 Unraveling the Trends and Disparities in Mortality of Liver Cirrhosis and Sepsis Across the United States: A 21-Year Retrospective Analysis

Introduction: Sepsis in liver cirrhosis (LC) patients is a dreaded complication and often overlooked. Our study examines the trends and mortality rates due to sepsis in liver cirrhosis patients across the U.S. adult population from 1999-2020, to serve as a guide for further management. Methods: Data was used from the CDC WONDER database, including adults aged 25 and older. Mortality data were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes K74.3-K74.6 and A41.9. AAMRs per 100,000 population. This was stratified by gender, race, census region, urban-rural classification, and state. JOINPOINT analysis done to estimate average annual percent changes (AAPCs) with 95% confidence intervals (CIs). Statistical significance was set at P < 0.05. Results: Between 1999 and 2020, liver cirrhosis and sepsis accounted for 83,551 deaths among adults aged ≥25 in the US. The overall AAMR for sepsis in liver cirrhosis-related deaths increased from 1.3282 in 1999 to 2.4387 in 2020, with an AAPC of 2.7641 (95% CI: 1.75 to 3.79, P < 0.000001). Men exhibited higher AAMRs compared to women (men: 2.12; women: 1.39). AAMRs for men and women increased steadily from 1999 to 2020 [AAPC: 2.05* (95% CI: 0.83 to 3.28, P = 0.00091)], [AAPC: 3.76* (95% CI: 3.19 to 4.32, P < 0.000001)], respectively. American Indian/Alaska Natives had the highest AAMRs (3.28), followed by Hispanics (3.02), Black population (1.83), White population (1.72), and Asians (1.14). AAPC values for AAMRs increased significantly for American Indians (3.07*) and White population (3.04*) while increased non-significantly for Hispanics (0.86), Asians (0.78) and Black population (0.66). Geographically, Metropolitan areas had higher AAMRs (1.729) than Non-metropolitan areas (1.702). AAPC values of AAMR is highest for NonCore (Nonmetro) which is 5.82*, followed by Micropolitan (4.53*), Small Metro (3.84), Medium Metro (3.67*), Large Fringe Metro (1.92*), and Large Central Metro (0.79). At the state level, the highest increases were seen in Maryland (APC: 22.98* from 2016–2020), Michigan (APC: 14.18* from 2017–2020), and *Oklahoma (APC: 10.51* from 2010–2020). States like Florida and New York showed earlier declines or stable trends. Conclusion: This analysis reveals key trends in liver cirrhosis-related sepsis mortality, showing disparities across gender, race, region, and urbanization. Men and American Indian/Alaska Natives had the highest mortality rates, highlighting health inequalities and the need for further targeted research and interventions.