C55-30 Sepsis-related ARDS in U.S. Hospitals: Predictors, Disparities, and Seasonal Trends - A Retrospective Analysis From the NIS Database 2018-2021

Abstract Purpose Acute Respiratory Distress Syndrome (ARDS) is a severe complication of sepsis and septic shock, carrying high mortality and worsening the outcomes. Despite advances in critical care, the changing trends and risk factors for ARDS in septicemia are not fully understood. This study aimed to identify clinical predictors, demographic disparities, and temporal trends associated with sepsis-related ARDS requiring invasive mechanical ventilation (IVM). Methods A retrospective analysis was conducted using data from the National Inpatient Sample (NIS) for the years 2018-2021. Adult hospitalizations were identified using ICD-10 codes for sepsis (A41.x, R65.21) and acute respiratory distress syndrome (ARDS; J80). The primary outcome was in-hospital mortality, while secondary outcomes were prolonged IVM, demographic disparities, and seasonal predisposition. Logistic regression models were used to evaluate the associations. Results Out of 102,000,458 weighted hospitalizations analyzed, only 462,036 (0.5%) met diagnostic criteria for ARDS. The overall mean age was 67.7 years, and 51.5% were male. ARDS patients were younger, more frequently male, and had substantially higher mortality than non-ARDS patients. Overall, in-hospital mortality was 6.8%, but patients with ARDS demonstrated significantly higher odds of death (p 0.001). Survivors were 3.83 times more likely to belong to the non-ARDS group (OR = 3.83, 95% CI: 3.63-4.03). Prolonged IMV (96 hours) was the strongest predictor of ARDS (OR = 11.71, 95% CI: 11.08-12.37, p 0.001). Septic shock independently increased ARDS risk (OR = 1.52, 95% CI: 1.45-1.56, p 0.001). Younger age was associated with higher ARDS risk, with each additional year reducing odds by 1.6% (OR = 1.016, p 0.001). Palliative care utilization was significantly higher among ARDS patients (9.1%, p = 0.003). Racial disparities were observed, Native Americans had the highest ARDS risk (OR = 0.62, 95% CI: 0.50-0.76), representing 38% greater odds of ARDS, while Black and Hispanic patients showed modestly elevated risk (OR = 1.27-1.33). Seasonal variation was notable, with peaks in January (OR = 2.04, 95% CI: 1.86-2.23) and February (OR = 1.88, 95% CI: 1.72-2.05), and the lowest risk in April (OR = 0.66, 95% CI: 0.60-0.72, p 0.001). The model demonstrated moderate explanatory power (Nagelkerke R² = 0.31) but low sensitivity for ARDS detection (0.3%), consistent with the rarity of ARDS events. Conclusion Sepsis-associated ARDS remains a rare but lethal complication with distinct clinical and seasonal patterns. Prolonged mechanical ventilation and septic shock are dominant predictors, while younger age, Native American race, and winter admissions confer elevated risk. This abstract is funded by: None