Long-term injectable non-insulin antidiabetic drug use and in-hospital mortality in sepsis: A nationwide analysis of the 2023 National Inpatient Sample

PURPOSE: Injectable non-insulin antidiabetic agents have hypothesized antiinflammatory effects in sepsis, but no nationally representative US inpatient analysis has examined their association with in-hospital outcomes. MATERIALS AND METHODS: Cross-sectional analysis of the 2023 National Inpatient Sample. Adults with any-listed sepsis and diabetes were included; exposure was documented long-term injectable non-insulin antidiabetic use (ICD-10-CM Z79.85). Survey-weighted logistic regression estimated adjusted odds of in-hospital mortality across three pre-specified comparators. RESULTS: Among 241,808 hospitalizations, 5238 (2.2%) carried Z79.85. Adjusted odds of death were 0.53 (95% CI, 0.45-0.63) versus the full cohort, 0.73 (0.61-0.87) therapy-matched, and 0.77 (0.64-0.93) versus oral therapy alone. The E-value was 1.61. CONCLUSIONS: Exposure was associated with lower in-hospital mortality, attenuating under stricter comparators. Findings are hypothesis-generating and subject to residual confounding.