Acute respiratory distress syndrome and non-metastatic solid tumor: A propensity score–matched analysis of the National Inpatient Sample database.

e14044 Background: Acute Respiratory Distress Syndrome (ARDS) remains a major cause of morbidity and mortality in hospitalized adults. Patients with non-metastatic solid tumors (NMST) may be at increased risk for adverse outcomes due to cancer-related inflammation and treatment-associated toxicities. Limited national-level data exist evaluating the impact of NMST on ARDS outcomes. This study assesses the association between NMST and inpatient outcomes among adults hospitalized with ARDS. Methods: The National Inpatient Sample (2017–2021) was analyzed to identify adults ≥18 years with ARDS using ICD-10 codes. Patients with missing data were excluded. Primary outcomes included inpatient mortality, length of stay (LOS), sepsis, and the need for endotracheal intubation or vasopressor support. Propensity score matching (PSM) was performed (1:1) to balance covariates between NMST and non-NMST groups. Matching variables included diabetes, COPD, coronary artery disease, hypertension, dyslipidemia, liver disease, obesity, obstructive sleep apnea, and pulmonary hypertension. Post-matching comparisons were conducted using univariate and multivariate regression models. Results: A total of 84,790 ARDS hospitalizations were identified, of which 2,617 involved NMST. The mean age was 60.3 ± 15.6 years, and 57.6% were male. After 1:1 PSM, 2,617 NMST patients were matched to 2,617 non-NMST patients, achieving standardized differences <0.10 across covariates. Compared with matched controls, NMST patients had higher rates of mortality (61.44% vs. 48.42%), sepsis (68.48% vs. 62.23%), and vasopressor use (17.88% vs. 16.11%). Rates of acute kidney injury (59.08% vs. 58.91%), endotracheal intubation (43.33% vs. 43.91%), and LOS (~18 days) were similar between groups. In adjusted analyses, NMST was significantly associated with increased mortality (OR 1.25; 95% CI 1.12–1.39; p<0.01) and sepsis (OR 1.27; 95% CI 1.13–1.43; p<0.01). Conclusions: NMST is independently associated with higher mortality and sepsis among adults hospitalized with ARDS. These findings highlight the need for early recognition and tailored management strategies for ARDS in patients with underlying NMST. Further research is warranted to define optimal approaches for this high-risk population.