(362) Impact of Palliative Care on Outcomes in Patients With Septic Shock

Introduction: Septic shock remains a significant cause of morbidity and mortality in hospitalized patients. The role of palliative care (PC) in managing these patients is crucial but not well-documented in large-scale studies. This study aims to evaluate the impact of palliative care on the outcomes of patients with septic shock using the National Inpatient Sample (NIS) data from 2016 to 2021.

Methods: Data were extracted from the NIS for patients diagnosed with septic shock between 2016 and 2021. Descriptive statistics and multivariate logistic regression were used to compare patients receiving palliative care to those not receiving palliative care.

Results: A weighted sample of 3,708,334 septic shock patients was analyzed, with 21.8% (n=807,275) receiving palliative care. Patients receiving palliative care were generally older, with a mean age of 70.32 years compared to 65.16 years in the non-palliative care group (p < 0.001). The palliative care group had higher rates of chronic heart failure (34.0% vs. 32.6%, p< 0.001), prior stroke (9.9% vs. 9.2%, p< 0.001), liver disease (24.6% vs. 19.0%, p< 0.001), chronic kidney disease (34.8% vs. 33.5%, p< 0.001), pneumonia (43.2% vs. 38.4%, p< 0.001) and COVID-19 (10.7% vs. 6.7%, p< 0.001). In-hospital mortality was significantly higher among palliative care patients at (66.3% vs. 24.5%; p< 0.001). Multivariate analysis revealed that palliative care was strongly associated with increased in-hospital mortality (OR=5.632; 95% CI 5.505-5.762, p< 0.001). Additional predictors of mortality included advanced age, Black, Hispanic, Asian race, chronic heart failure, liver disease, chronic kidney disease, COVID-19 and pneumonia.

Conclusions: This study highlights the demographic and clinical differences between septic shock patients receiving palliative care with standard treatment. The integration of palliative care in the management of septic shock is associated with a higher in-hospital mortality rate, reflecting its role in end-of-life decision-making for critically ill patients. Our study demonstrates the need for careful consideration of palliative care to ensure it aligns with patient goals and improves the quality of life in this high-risk population.