S1392 Serum Lactate Thresholds in the Diagnosis of Septic Shock in Patients With Cirrhosis: Validation of 2016 Surviving Sepsis Guidelines

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is known to be associated with low-grade inflammation, oxidative stress and ectopic fat/metabolic syndrome. There are studies showing increased prevalence of Non-alcoholic fatty liver disease/Non-alcoholic steatohepatitis (NASH) in patients with COPD. This study is to compare and evaluate the outcome of acute exacerbation of COPD in patients with NASH compared to non-NASH population. Methods: We used the 2018 National Inpatient Sample (NIS) database. Using ICD-10 codes, we queried the database for adults with diagnosis of acute exacerbation of COPD with and without NASH. The primary outcome was odds of mortality and secondary outcome was mean length of stay. Results: A total of 892220 AE of COPD discharges, 2150 discharges had diagnosis of NASH. The NASH group were relatively young (66.8 years vs 70.3 years), more female (67.9% vs 52.7%), more total hospital cost ($83263 vs $74340) and obese (43.2% vs 20.8%) however with less smokers (27.2% vs 35.3%), less pulmonary embolism (0.2% vs 1.7%). There was total of 160 deaths (7.4%) in NASH cohort versus 45950 (5.1%) in non-NASH cohort. Using univariate regression analysis, we found that the unadjusted mortality was higher in patients with NASH compared to the non-NASH patients and was statistically significant [Odds ratio (OR) 1.47, 95% CI (1.02 -2.13), p-value 5 0.03]. After adjusting for age, gender, race, Charlson index, hospital location, ACS, pneumonia, pulmonary embolism, obstructive sleep apnea, pulmonary hypertension, pleural effusion, respiratory failure, mechanical ventilation, atrial fibrillation/flutter using multivariate regression analysis revealed a similar result with increased odds of mortality among NASH patients compared to non-NASH patients and was statistically significant [OR 1.52 95% CI (1.03-2.23), p-value 5 0.031].The mean length of stay was longer for patients in NASH group compared to non-NASH group, however after adjusting using multivariate regression analysis, it wasn't statistically significant (OR 1.4, CI:0.34 -5.65; p-value: 0.63). The disposition of discharge was near evenly distributed among different groups. Conclusion: Our study showed increased mortality among patients with NASH presenting for AE of COPD compared to patients with non-NASH. This was also associated with increased hospital cost without statistically significant longer length of stay. Further studies would be needed to assess the burden of disease on COPD patients and the subsequent outcome.