Race as Predictor of Septic Shock Outcomes: A Comprehensive Nationwide Analysis (2016-2020)

Author(s):
Amir Sohail; Abu baker Sheikh

Background:

Septic shock continues to be a major health concern for the US. With evolving definitions of sepsis and management strategies, it is important to evaluate racial variations in outcomes of septic shock using current data. We aimed to gain insight into racial variation in outcomes of septic shock and understand underlying factors.

Hypothesis:

We hypothesized that racial minorities has worse outcomes with septic shock versus White patients

Methods:

We queried the Healthcare Quality and Utilization Project National Inpatient Sample database from 2016 to 2020 using ICD-10-CM codes for septic shock, initial encounter (T81.12XA), and severe sepsis with septic shock (R65.21). We grouped patients by race and compared patient and hospital characteristics, outcomes, and
complications between groups. All patients ≥18 years of age and admitted to the hospital with septic
shock. We excluded patients <18 years of age and those without race/ethnicity data. We used data from 2,789,890 patients with septic shock.

The primary outcome of this study was in-hospital mortality. The secondary outcomes were intubation and mechanical ventilation, vasopressor use, acute kidney injury, need for hemodialysis, acute myocardial infarction, requirement for blood transfusion, length of stay, the financial burden on healthcare, and resource utilization.

Results:

Out of 2,789,890 patients with septic shock, 67.5% were White, 14.4% were African American, 10.89% were Hispanic, 3.328% were Asian or Pacific Islander, and 0.84% were Native American. Majority (46.25 %) of the study population were >70 years of age.

On multivariable logistical regression analyses, White patients (reference group) showed lower in-hospital odds of mortality compared to all non-White racial groups. Odds ratios are as follows: African AmericanBlack 1.23 (1.21 – 1.25), Hispanic 1.11 (1.109 – 1.13), Asian or Pacific Islander 1.106 (1.03 to 1.10), Native American 1.219 (1.12 to 1.326) and other racespatients 1.23 (1.219 to 1.327).

With regards to secondary outcomes, statistically significant differences were found between White and non-White populations. Non-White populations had higher odds of vasopressor requirement, non-invasive and invasive mechanical ventilation, requirement of hemodialysis or blood transfusion, acute myocardial infarction, acute respiratory distress syndrome, cardiac arrest, and acute liver failure.

Conclusions:

Our findings suggest that non-White populations have higher odds of mortality and end-organ failure from septic shock compared to White populations.