S2886 Temporal Shifts in Mortality Trends of Liver Cirrhosis With Associated Complications Leading to Multi-Organ Failure: A Retrospective Analysis From CDC WONDER 1999-2023

Introduction: Cirrhosis, the 11th leading cause of death in the U.S., progresses to decompensated cirrhosis, causing complications like multiorgan failure, accelerating morbidity and mortality. Research on related mortality trends is limited. This study aims to analyze U.S. mortality trends in cirrhosis patients with multiorgan failure from 1999 to 2023. Methods: Mortality data among adults aged ≥45 from the CDC WONDER database from 1999 to 2023 were analyzed using International Classification of Diseases, Tenth Revision (ICD-10) codes related to cirrhosis (K70.2, K70.3, K74) as the underlying cause of death and multiorgan failure (heart failure: I50; respiratory failure: J96; renal failure: N17–N19; liver failure: K72; encephalopathy: G93; hepatorenal syndrome: K76.7; sepsis: A41, DIC: D65) as the multiple cause of death. Age-adjusted mortality rates (AAMR) were quantified per 100,000 people (95%CI) by standardizing crude mortality rates (CMRs). Annual percent change (APC) and average annual percent change (AAPC) were calculated using Joinpoint regression software. Results: A total of 331,811 cirrhosis-related complications leading to multiorgan failure deaths occurred from 1999 to 2023, majorly occurring in medical facilities (67.09%). AAMR declined from 1999 to 2009, followed by an increase until 2021 and stable values thereafter until 2023 (AAPC: 0.98; 95% CI: 0.78 to 1.17). Adults aged 75-84 years had the highest CMR, though 55–64-year-olds had the highest rate of mortality (AAPC: 1.64; 95% CI: 1.35 to 1.94). Men had a higher average AAMR, though women had a higher rate of mortality (AAPC women: 1.36; 95%CI: 1.03 to 1.73). Racially, non-Hispanic American Indian/Alaska Natives had the highest average AAMR, along with the highest rate of mortality (AAPC: 2.40; 95% CI: 1.29 to 3.56). State-wise, California saw the highest percentage of deaths (14.08%). Regionally, the West had the highest average AAMR along with the highest rate of mortality (AAPC: 1.38; 95% CI: 1.0 to 1.74). From 1999 to 2020, rural areas had a higher average AAMR compared to urban areas, along with a higher rate of mortality (AAPC: 1.73; 95% CI: 1.48 to 2.00). Conclusion: Overall, AAMR has increased from 2009 to 2018, subsequently remaining flat until 2023. Significant disparities were noted among demographic and regional stratifications throughout. These concerning results highlight the need for further investigation to address the disparities and public health policy changes to address at-risk communities.