Hospitalization patterns in metastatic melanoma patients with and without sepsis.

Abstract

e21554 Background: Metastatic melanoma is an aggressive malignancy with a high risk of complications, including sepsis, a significant cause of morbidity and mortality. Sepsis is associated with 8.5% of all cancer deaths at an estimated cost of $3.4 billion per year. In 2016, NCCN guidelines were updated to recommend immune checkpoint inhibitors (ICIs) as first-line therapy for advanced melanoma. Various studies have reported variable effects on the rate of infections in patients receiving ICIs, with the main risk factors for severe infections identified as receipt of corticosteroids and infliximab. In this study, we characterized trends in in-hospital outcomes for patients with metastatic melanoma and sepsis since 2016. Methods: Data were collected from the National Inpatient Sample (2016-2021), consisting of all-payer administrative data approximating a 20% stratified sample of all discharges from U.S. community hospitals. Patients with metastatic melanoma as well as other metastatic cancers were included. We identified patients with uncomplicated sepsis, severe sepsis, and septic shock using ICD-10 codes. Demographics and hospitalization outcomes were compared between hospitalized patients with metastatic melanoma and sepsis versus no sepsis using chi-squared and Wilcoxon Rank Sum tests. Trends were assessed using unadjusted linear regression. Results: Among 979,009 hospitalizations for metastatic melanoma and other metastatic cancers, 8.23% had an ICD-10 code relating to uncomplicated sepsis, 2.70% had severe sepsis, 4.36% had septic shock. From 2016 to 2021, the overall percentage of hospitalizations with sepsis increased from 13.40% to 16.68% (p < 0.001 for trend). Average age (66.3 vs 65.9 years), sex (54.3% vs 50.9% male), race/ethnicity, and primary payer status between those with and without sepsis were similar. Hospitalizations for sepsis had substantially higher in-hospital mortality (23.6% vs 6.3%, p < 0.001), hospital charges ($107,368 vs $67,587, p < 0.001), and lengths of stay (8.55 vs 5.90 days, p < 0.001) than hospitalizations without sepsis. Conclusions: In this large, national sample of hospitalized patients with metastatic melanoma, the prevalence of sepsis increased over time, highlighting a growing burden of infection-related complications in this population. Patients with sepsis experienced significantly worse outcomes, including increased mortality, increased costs, and longer stays. Further research is needed to understand the determinants of sepsis-related morbidity and mortality in this population given the growing use of ICIs.