P4060 - Septic Shock in Perforated Peptic Ulcer Disease: Who’s at Risk? Insights From a National Cohort in the United States

Adishwar Rao, MD, MPH¹, Dushyant S. Dahiya, MD², Arthur Cecchini, MD³, Saqr Alsakarneh, MD, MSc⁴, Sheza Malik, MD⁵, Akriti Agrawal, MD, MPH³, Fariha Hasan, MD⁶, Omar Al Ta’ani, MD⁷, Hareesha Rishab Bharadwaj, ⁸, Hassam Ali, MD⁹, Raja Chandra Chakinala, MD¹, Subash Ghimire, MD³, Amlish B. Gondal, MD¹, Michael Georgetson, MD, FACG¹⁰
1Guthrie Robert Packer Hospital, Sayre, PA, Sayre, PA; 2University of Kansas School of Medicine, Kansas City, KS; 3Guthrie Robert Packer Hospital, Sayre, PA; 4Mayo Clinic, Rochester, MN; 5Emory University, Atlanta, GA; 6Cooper University Hospital, Camden, NJ; 7Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA, Pittsburgh, PA; 8The University of Manchester, Manchester, England, United Kingdom; 9East Carolina University/Brody School of Medicine, Greenville, NC; 10Guthrie Robert Packer Hospital, Department of Gastroenterology, Sayre, PA

Introduction: Septic shock remains a critical determinant of mortality in patients hospitalized with perforated peptic ulcer disease (PUD). While the risk of sepsis in gastrointestinal perforations is well known, limited national data exist specifically identifying factors associated with progression to septic shock in this cohort. Given the high morbidity, mortality, and healthcare utilization associated with septic shock, understanding patient- and disease-level predictors can guide early identification and intervention strategies.

Methods: We conducted a retrospective study using the National Inpatient Sample database from 2016 to 2021 to identify adult hospitalizations with perforated PUD using ICD-10-CM codes. We analyzed baseline demographics, comorbidities, and clinical outcomes. The primary outcome was the development of septic shock, identified using validated ICD-10 CM codes. Multivariable logistic regression was used to identify independent predictors of septic shock, adjusted for confounders including age, sex, race/ethnicity, and comorbid conditions. Adjusted odds ratios (aOR) with their respective 95% confidence intervals (95% CI) and p-values were reported.

Results: Out of an estimated 2,561,379 weighted hospitalizations for PUD, 207,970 (8.1%) involved perforation. Among patients with perforated PUD, septic shock occurred in 12.9% patients. On multivariate analysis, increasing age was a strong predictor of septic shock: age 45-64 y (aOR 2.26, 95% CI 1.99-2.56, p< 0.001) and ≥65 y (aOR 2.69, 95% CI 2.36-3.07, p< 0.001) compared to age 18–44 y. Female sex was associated with lower odds of septic shock (aOR 0.83, 95% CI 0.78-0.89, p< 0.001). Significant comorbid predictors included heart failure (aOR 1.85, 95% CI 1.70-2.01), chronic kidney disease (aOR 1.34, 95% CI 1.24-1.46), COPD (aOR 1.58, 95% CI 1.46-1.71), liver cirrhosis/fibrosis (aOR 1.40, 95% CI 1.21-1.63), and obesity (aOR 1.37, 95% CI 1.26-1.48) (all p< 0.001). COVID-19 infection was associated with a significantly increased risk of septic shock (aOR 2.36, 95% CI 1.90-2.94).

Discussion: Septic shock affects nearly one in eight patients hospitalized with perforated PUD and is associated with older age and multiple chronic comorbidities. Identifying clinically significant predictors of mortality can help clinicians identify high-risk patients early in the hospital course and inform risk stratification, early intervention protocols, and resource allocation in managing patients with perforated PUD.

Disclosures:
Adishwar Rao indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.
Arthur Cecchini indicated no relevant financial relationships.
Saqr Alsakarneh indicated no relevant financial relationships.
Sheza Malik indicated no relevant financial relationships.
Akriti Agrawal indicated no relevant financial relationships.
Fariha Hasan indicated no relevant financial relationships.
Omar Al Ta’ani indicated no relevant financial relationships.
Hareesha Rishab Bharadwaj indicated no relevant financial relationships.
Hassam Ali indicated no relevant financial relationships.
Raja Chandra Chakinala indicated no relevant financial relationships.
Subash Ghimire indicated no relevant financial relationships.
Amlish Gondal indicated no relevant financial relationships.
Michael Georgetson indicated no relevant financial relationships.

Adishwar Rao, MD, MPH¹, Dushyant S. Dahiya, MD², Arthur Cecchini, MD³, Saqr Alsakarneh, MD, MSc⁴, Sheza Malik, MD⁵, Akriti Agrawal, MD, MPH³, Fariha Hasan, MD⁶, Omar Al Ta’ani, MD⁷, Hareesha Rishab Bharadwaj, ⁸, Hassam Ali, MD⁹, Raja Chandra Chakinala, MD¹, Subash Ghimire, MD³, Amlish B. Gondal, MD¹, Michael Georgetson, MD, FACG¹⁰. P4060 - Septic Shock in Perforated Peptic Ulcer Disease: Who’s at Risk? Insights From a National Cohort in the United States, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.