Exploring racial disparities in biliary tract cancer with sepsis.

Abstract

e16185 Background: Biliary tract cancers (BTCs) account for 3% of all cancers. In 2021, the incidence of BTCs was 15.8 per 100,000 among Hispanics (HP), 11.2 among Asian Pacific Islanders (AP), 10.1 among African Americans (AA), and 7.8 among American Whites (AW). Cancer increases the risk of infections due to myelosuppression, mucositis, and bacterial translocation. BTCs with severe sepsis (SS) tend to have higher mortality. Hence, we aimed to investigate racial disparities in mortality in BTCs with SS. Methods: We analyzed the National Inpatient Sample (2016–2021) for adults with BTCs and SS. Critical illness (ICU) was defined as the presence of acute kidney injury (AKI) requiring hemodialysis, invasive ventilation, vasopressors, or shock. Mortality was analyzed based on racial disparities (AW, AA, HP, and AP) among patients who met ICU criteria. Further stratification was performed based on Gram-negative (Gn) infections and the timing of drainage procedures. Multivariate regression analysis was conducted, adjusting for sociodemographic factors and comorbidities, and using AW as the reference group. A p-value ≤0.05 was considered statistically significant. Results: Of the 22,305 BTCs with SS, 68.6% met the criteria for ICU-level care. In this cohort, 34.6% experienced mortality, and AA had the highest mortality, followed by AP, AW, and HP (46.3%, 36.9%, 32.9%, and 29.3% respectively). After adjusting for the factors mentioned above, mortality was higher in AA than AW (OR 1.4, 95% CI 1.04-1.8, p < 0.05), while mortality did not differ between the other races (p > 0.05). 27.8% underwent drainage procedures and 25.6% of those patients had mortality. In the drainage group, mortality was highest in AA, followed by AP, AW, and HP (34.1%, 29.6%, 25.7%, and 19% respectively). Procedure timing following admission affected mortality in the AW and HP (< 72 hours vs > 240 hours: 55.3% vs 56.3%; 14.2% vs 25%), while mortality decreased in AA and AP (< 72 hours vs > 240 hours: 13.5% vs 12.5%; 11.4% vs 6.3%). However, racial disparities did not significantly influence mortality based on procedure timing (p > 0.05). The mortality rate in the ICU cohort with Gn sepsis was 22.9%. AA had the highest mortality in the Gn cohort, followed by AP, AW, and HP (36.3%, 28.3%, 20.9%, and 17.3% respectively). After adjusting, AA had higher mortality than AW (OR 1.7, 95% CI 1.0-3.0, p = 0.05) but mortality did not differ in the other races (p > 0.05). Of AA having BTCs and SS, factors contributing to mortality were invasive ventilation (OR 5.6, p < 0.001), AKI requiring hemodialysis (OR 5.5, p = 0.01), and shock (OR 3.4, p < 0.05). The area under the curve for these factors was 0.766. Conclusions: In biliary tract cancer patients with severe sepsis, African American patients had higher mortality compared to American Whites. Intensive monitoring and a multidisciplinary care approach are required to improve outcomes for those with critical illness.