e16204 Background: Sepsis is a frequent and often terminal complication in patients with malignant neoplasms of the liver and intrahepatic bile ducts. Population-level trajectories and disparities in sepsis-related mortality among adults with liver malignancy have not been fully described. This study quantifies temporal, demographic, and geographic patterns in sepsis-related mortality among adults with liver malignancy in the United States from 1999 through 2023. Methods: We analyzed multiple-cause-of-death data from the CDC WONDER database from 1999–2023 for deaths among adults aged ≥25 years in which codes for ICD-10 for sepsis (A40–A41) and malignant neoplasm of the liver and intrahepatic bile ducts (C22) co-occurred. Age-adjusted mortality rates (AAMR) per 1,000,000 population were extracted. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Results: From 1999 to 2023, 24,924 sepsis-related deaths were recorded among adults with liver malignancy. The overall mean AAMR increased substantially from 2.41 in 1999 to 6.85 in 2023, representing an AAPC of 5.10% (95% CI: 4.83-5.36). Males experienced higher mortality (5.72) than females (2.72), though both sexes showed steep increases (AAPC: 5.18% vs. 4.91%). All racial groups demonstrated increasing mortality during the study period. Racial stratification revealed the highest mean AAMR among Non-Hispanic Asian or Pacific Islanders (8.88), followed by Hispanic or Latino (7.09) and Non-Hispanic Black or African Americans (6.48). Adults aged ≥65 years bore the greatest burden, with crude mortality rate rising from 7.85 in 1999 to 22.40 in 2023. Mortality rates remained consistently elevated for both the 65–85+ and 45–64 age groups during the study period. Metropolitan areas had a higher mean AAMR than non-metropolitan areas (3.93 vs. 2.94). Geographic disparities were pronounced, with states exhibiting the highest AAMRs in 2021-2023 including California (10.04), Washington (9.28), Texas (9.02), Kentucky (8.72), and Delaware (8.16); those with the lowest rates included West Virginia (3.85), North Carolina (4.35), Virginia (4.56) and Wisconsin (4.64). Regionally, the West had the highest mean AAMR at 5.14, followed by the Northeast (4.14), South (4.00), and Midwest (3.18). Most deaths occurred in inpatient medical facilities (84.5%). Conclusions: Sepsis-related mortality among adults with liver malignancy increased substantially over 25 years across most demographic and geographic strata. Pronounced disparities among Asian or Pacific Islander populations, males, older adults, and residents of Western states underscore the urgent need for targeted sepsis prevention strategies, early recognition protocols, and improved end-of-life care for patients with hepatobiliary malignancies.
Kambhampati et al. (Thu,) studied this question.