Abstract Background Septic shock is one of the most resource-intensive and deadly critical care conditions, with 34.7% 30-day mortality (1). A patient’s DNR order upon admission indicates their resuscitation wishes. Doctors may interpret it as an indication that the patient prefers less aggressive care. This perception may affect results, complicate clinical decision-making, and raise concerns about care quality (2-4). A large, nationally representative cohort was used to compare inpatient outcomes for DNR and non-DNR patients. Methods We used ICD-10 codes to retrospectively analyze septic shock patients from 2019-2022 in the National Inpatient Sample (NIS) database. Patients were divided into two groups: those with an established DNR on admission and those without. We compared the odds of in-hospital outcomes, adjusted for demographic, hospital, and clinical confounders, using univariate and multivariate analyses. Results There were 9,077,101 admissions for septic shock; 1,804,944 (19.8%) had an established DNR on admission, and 7,371,982 (81.2%) did not. The primary outcome was in-hospital mortality. Secondary outcomes included palliative care (PC) utilization, length of stay (LOS), total charges (TOTCHG), acute kidney injury (AKI), and discharge disposition (DD). There was higher mortality in the DNR group (0.34 vs 0.05, adjusted odds ratio aOR 8.86, confidence interval CI 8.65-9.06, p 0.001). Regarding secondary outcomes, in the DNR group, there was higher utilization of PC (0.42 vs 0.03, aOR 21.4, CI 20.8-21.9, p 0.001), higher TOTCHG (110,900 vs 97,148, coefficient CoE 18,236, CI 16,987-19,484, p 0.001), and a greater incidence of AKI (0.54 vs 0.39, aOR 1.41, CI 1.39-1.42, p 0.001). The study revealed a shorter LOS (7.9 vs 7.6, aOR 0.28, CI 0.23-0.32, p 0.001) and a higher likelihood of facility discharges compared to non-DNR patients (CoE 0.20, CI 0.197-0.203, p 0.001). Discussion Among patients with septic shock with established DNRs, there were increased mortality rates, utilization of palliative care, and organ dysfunction. The findings highlight the difficulties in integrating clinical management with patient preferences, particularly when DNR may be perceived as limiting treatment intensity. Distinguishing resuscitation preferences from the overall therapeutic intent is crucial, and efforts must be made to guarantee clear communication regarding the extent of care desired. As physicians, we must be honest and transparent with patients and their families and with ourselves about what DNR truly means to ensure choices reflect their values rather than misconceptions. Promoting early, nuanced goals-of-care discussions may reduce uncertainty, guide ethical decisions, and improve outcomes for this vulnerable population. This abstract is funded by: None
Taha et al. (Fri,) studied this question.