Abstract Background Myxedema coma represents the most severe and life-threatening manifestation of hypothyroidism, characterized by high morbidity and mortality and requiring early recognition and critical care intervention. The role and determinants of palliative-care involvement in this population remain poorly described. Understanding clinical predictors and outcomes associated with palliative consultation may inform multidisciplinary management and end-of-life care decisions. Methods We performed a cross-sectional analysis of the 2021 Nationwide Readmissions Database. Adult hospitalizations with a principal diagnosis of myxedema coma were identified using ICD-10-CM codes. Survey-weighted descriptive statistics and multivariable regression models estimated predictors of ICU-level care, palliative-care consultation, in-hospital mortality, length of stay (LOS), and total hospital charges. Significance defined as p 0. 05. Results A total of 1, 557 weighted admissions for myxedema coma were identified. The mean age was 66. 9 years, and 70. 7% were female. ICU-level care occurred in 35. 2% of hospitalizations, and airway support was required in 25. 7%. Predictors of ICU admission included shock (OR 6. 58, p 0. 001), sepsis (OR 5. 35, p 0. 001), and younger age (OR 0. 99 per year, p = 0. 01). The in-hospital mortality rate was 9. 5% and was independently associated with older age (aOR 1. 08 per year, p 0. 001), acute kidney injury (aOR 1. 88, p = 0. 038), and ICU-level care (aOR 4. 10, p 0. 001). Palliative-care consultation occurred in 13. 6% of hospitalizations, more often among ICU patients (17. 7%) than non-ICU (11. 4%; p = 0. 017). Among those who died, 57. 9% received palliative care. Independent predictors of palliative involvement included older age (aOR 1. 05 per year, p 0. 001), higher comorbidity index (aOR 4. 23, p = 0. 016), and ICU-level care (aOR 1. 70, p = 0. 024). Cancer (aOR 2. 86, p = 0. 12) and sepsis (aOR 1. 78, p = 0. 09) showed positive but nonsignificant trends, while dementia showed no association (aOR 1. 20, p = 0. 47). The mean LOS was 11. 4 days, and mean hospital charges were 105, 518. Palliative consultation was not associated with longer LOS (+1. 6 days, p = 0. 61) or higher cost (-4, 210, p = 0. 78). ICU care and sepsis were dominant cost drivers (both p 0. 01). Conclusions Among U. S. hospitalizations for myxedema coma, mortality and ICU utilization remain high. Palliative-care involvement is concentrated among older, comorbid, and critically ill patients but does not increase LOS or cost. These findings highlight the need for early recognition, aggressive organ support, and timely palliative integration in severe hypothyroidism. This abstract is funded by: none
Anagreh et al. (Fri,) studied this question.