Abstract Introduction Septic shock in young adults is often viewed as a reversible, low-risk condition. However, the impact of underlying immunodeficiency on outcomes in this population remains poorly defined. Identifying this high-risk subgroup is essential to guide timely recognition, aggressive management, and targeted post-acute care. Methods Using the 2022 Nationwide Readmissions Database, we identified adults aged 18-40 years hospitalized with septic shock. Immunodeficiency was defined using validated ICD-10 codes. In-hospital outcomes and resource utilization were compared between immunodeficient and non-immunodeficient patients. Outcomes included all-cause Inpatient mortality, invasive mechanical ventilation (IMV) use, continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), discharge disposition, length of stay (LOS), and total hospital charges. Group differences in continuous and categorical variables were assessed using standard statistical tests for means and proportions. Results Among 390, 489 young adults hospitalized with septic shock, 19, 846 (5. 1%) had immunodeficiency. In-hospital all-cause mortality was significantly higher in immunodeficient patients compared with non-immunodeficient patients (27. 2% vs. 23. 0%; P = 0. 001). Use of advanced organ support was more frequent among the immunodeficient group, including CRRT (12. 7% vs. 9. 5%; P = 0. 002) and ECMO (3. 9% vs. 1. 9%; P 0. 001), whereas IMV utilization was slightly lower (44. 4% vs. 49. 9%; P = 0. 002). Non-home discharge rates were comparable between groups (34. 0% vs. 31. 8%; P = 0. 13). Immunodeficient patients demonstrated greater healthcare utilization, with a mean increase of 4. 9 hospital days (P 0. 001) and total charges of 183, 000 higher (P 0. 001). Conclusions Our study showed that immunodeficiency identifies a vulnerable population of young adults with septic shock who face disproportionately higher mortality, greater reliance on advanced organ support, and substantially increased healthcare costs despite similar discharge outcomes. These findings challenge the assumption that younger age mitigates the severity of septic shock and highlight the need for early recognition, immune-specific management, and structured post-acute care. Targeted strategies to enhance resuscitation and recovery may reduce both the clinical and economic burden in this vulnerable population. This abstract is funded by: None
Khan et al. (Fri,) studied this question.