Comorbidities and outcomes in patients with Acute Myeloid Leukemia with and without type II diabetes mellitus admitted for chemotherapy: A national inpatient sample analysis

Abstract

Abstract Introduction- Acute myeloid leukemia (AML) often has co-existing type II diabetes mellitus (TIIDM), and poor glycemic control has been associated with worse outcomes. However, there is a lack of large-scale, real-world data exploring the impact of TIIDM on hospitalized AML patients. We aimed to evaluate inpatient outcomes in AML patients with and without TIIDM admitted for chemotherapy initiation. Methods- After identifying hospitalizations for AML requiring admission for chemotherapy initiation using the International Classification of Diseases, 10th Revision (ICD-10) codes, we queried the 2016–2021 National Inpatient Sample data for hospitalizations with TIIDM (Cohort 1) and without TIIDM (Cohort 2). Hospitalizations less than 18 years old and TIDM were excluded. Rao-Scott chi-square tests and two-sample t-tests were used to identify associations and compare numerical variables between cohorts respectively. A Bonferroni correction was used where appropriate. Multivariate logistic regression analysis was done to assess the effect of TIIDM on in-hospital mortality after adjusting for age, sex, comorbidities, and complications. The data were analyzed using SAS Studio. Results- We identified 17,278 (82.71%) and 3,611 (17.29%) admissions for cohorts 1 and 2 respectively. Cohort 1 patients were older (mean age 63.27 vs. 55.98 years; p<0.001) and more likely male (Odds ratio (OR) 1.31; 95% confidence interval (CI) 1.21-1.41). There were no significant differences in the mean length of stay (9.26 vs 19.57 days; p=0.338), or total hospital charges ($25,4636 vs $26,3505; p=0.155). However, in-hospital mortality was significantly higher in Cohort 1 (OR 1.27; 95% CI 1.10–1.46). Palliative care consults were similar between groups (OR 0.94; 95% CI 0.81-1.09), though do not resuscitate status was more common in Cohort 1 (OR 1.26; 95% CI 1.11-1.43). Cohort 1 had higher odds of comorbidities—congestive heart failure (CHF) (OR 1.89; 95% CI 1.69-2.12), dementia (OR 1.87; 95% CI 1.25-2.81), cerebrovascular disease (CVD) (OR 1.46; 95% CI 1.25-1.71), chronic kidney disease (OR 2.79; 95% CI 2.49-3.14), atrial fibrillation (AF) (1.49; 95% CI 1.33-1.67), previous percutaneous coronary intervention (OR 2.14; 95% CI 1.78-2.58), previous coronary artery bypass graft (OR 3.19; 95% CI 2.57-3.96), peripheral vascular disease (OR 1.32; 95% CI 1.10-1.59), liver diseases (OR 1.56; 95% CI 1.34-1.82), and obesity (OR 2.45; 95% CI 2.23-2.70); cohort 1 had significantly lower odds of alcohol use disorder (OR 0.68; 95% CI 0.46-0.99), and drug use (OR 0.59; 95% CI 0.40-0.89). Cohort 1 had higher odds of complications— acute kidney injury (AKI) (OR 1.65; 95% CI 1.50-1.80), need for renal replacement therapy (OR 1.77; 95% CI 1.41-2.20), tumor lysis syndrome (TLS) (OR 1.37; 95% CI 1.18-1.59), pulmonary failure (PF) (OR 1.37; 95% CI 1.11-1.71), and need for mechanical ventilation (OR 1.51; 95% CI 1.10-2.09). On multivariate analysis adjusting for comorbidities and complications, TIIDM was not an independent predictor for mortality in AML patients. Independent predictors for in-hospital mortality for AML patients were sepsis (OR 7.53; 95% CI 6.43-8.81), AKI (OR 3.98; 95% CI 3.43-4.61), PF (OR 3.60; 95% CI 2.74-4.73), disseminated intravascular coagulation (OR 1.65; 95% CI 1.22-2.23), TLS (OR 1.63; 95% CI 1.31-2.03), CHF (OR 1.23; 95% CI 1.01-1.50), malnutrition (OR 1.52; 95% CI 1.30-1.79), CVD (OR 3.19; 95% CI 2.52-4.03), AF (OR 1.90; 95% CI 1.58-2.28), and liver diseases (OR 2.35; 95% CI 1.88-2.92). Conclusion- Cohort 1 had higher odds of several comorbidities, complications, and in-hospital mortality for AML patients requiring hospitalization for inpatient chemotherapy. But on multivariate analysis adjusting for these variables, TIIDM was not an independent predictor of in-hospital mortality. Comorbidities and complications associated with TIIDM were themselves independent predictors. These findings suggest that TIIDM may contribute to poorer outcomes in AML patients through its association with other high-risk clinical features. Further studies are required to better understand this relationship between TIIDM and AML, and guide individualized management.