Stable Nationwide Sepsis-Related Mortality Does Not Extend to Individuals with Alcohol-Associated Liver Disease.

BACKGROUND AND AIMS: Sepsis remains highly fatal despite national improvements from the Surviving Sepsis Campaign; furthermore, its effects on patients with alcohol-associated liver disease (ALD) are not well understood.

METHODS

Using the Centers for Disease Control and Prevention Wide-raning Online Data for Epidemiological Research (CDC WONDER) death certificate data from 2011 to 2020, we identified deaths with sepsis as the underlying cause and ALD as a contributing cause. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated overall and by sex, race/ethnicity, region, and urbanization level.

RESULTS

Between 2011 and 2020, a total of 2357 sepsis-related deaths occurred among ALD patients in the United States (U.S.) While sepsis-related mortality in the overall population remained stable (APC: - 0.88%, 95% CI [confidence interval] - 2.00 to 0.25%), it increased significantly in ALD patients (APC: 8.86%, 95% CI 5.07 to 12.79%). Mortality increased in both sexes, with mortality in females (APC: 9.68%, 95% CI 4.58 to 15.03%) increasing more pronouncedly than in males (APC: 7.79%, 95% CI 4.13 to 11.58%). AAMRs from sepsis-related mortality in ALD individuals increased in the Midwest (APC: 10.77%, 95% CI 4.58 to 17.33%), South (APC: 6.78%, 95% CI 0.26 to 13.73%), and West (APC: 7.35%, 95% CI 3.16 to 11.71%) census areas while remaining stable in the Northeast census area.

CONCLUSION

Despite sepsis-related mortality in the U.S. population remaining stable, rates among ALD patients have increased over the past decade. These patterns underscore disparities and the need for targeted interventions such as enhancing early sepsis detection, expanding specialty access, and strengthening alcohol use treatment pathways.