S3073 Septic Shock in Perforated Peptic Ulcer Disease: Who’s at Risk? Insights From a National Cohort in the United States

Introduction: Septic shock remains a critical determinant of mortality in patients hospitalized with perforated peptic ulcer disease (PUD). While the risk of sepsis in gastrointestinal perforations is well known, limited national data exist specifically identifying factors associated with progression to septic shock in this cohort. Given the high morbidity, mortality, and healthcare utilization associated with septic shock, understanding patient- and disease-level predictors can guide early identification and intervention strategies. Methods: We conducted a retrospective study using the National Inpatient Sample database from 2016 to 2021 to identify adult hospitalizations with perforated PUD using International Classification of Diseases-10-CM codes. We analyzed baseline demographics, comorbidities, and clinical outcomes. The primary outcome was the development of septic shock, identified using validated International Classification of Diseases-10 CM codes. Multivariable logistic regression was used to identify independent predictors of septic shock, adjusted for confounders including age, sex, race/ethnicity, and comorbid conditions. Adjusted odds ratios (aOR) with their respective 95% confidence intervals (95% CI) and P values were reported. Results: Out of an estimated 2,561,379 weighted hospitalizations for PUD, 207,970 (8.1%) involved perforation. Among patients with perforated PUD, septic shock occurred in 12.9% patients. On multivariate analysis, increasing age was a strong predictor of septic shock: age 45-64 y (aOR 2.26, 95% CI 1.99-2.56, P < 0.001) and ≥65 y (aOR 2.69, 95% CI 2.36-3.07, P < 0.001) compared to age 18–44 y. Female sex was associated with lower odds of septic shock (aOR 0.83, 95% CI 0.78-0.89, P < 0.001). Significant comorbid predictors included heart failure (aOR 1.85, 95% CI 1.70-2.01), chronic kidney disease (aOR 1.34, 95% CI 1.24-1.46), chronic obstructive pulmonary disease (aOR 1.58, 95% CI 1.46-1.71), liver cirrhosis/fibrosis (aOR 1.40, 95% CI 1.21-1.63), and obesity (aOR 1.37, 95% CI 1.26-1.48) (all P < 0.001). Coronavirus disease 2019 infection was associated with a significantly increased risk of septic shock (aOR 2.36, 95% CI 1.90-2.94). Conclusion: Septic shock affects nearly 1 in 8 patients hospitalized with perforated PUD and is associated with older age and multiple chronic comorbidities. Identifying clinically significant predictors of mortality can help clinicians identify high-risk patients early in the hospital course and inform risk stratification, early intervention protocols, and resource allocation in managing patients with perforated PUD.