Economic burden of cytokine release syndrome in older adults and underserved populations: A Nationwide Inpatient Analysis (2019–2021).

Abstract

e24097 Background: Cytokine release syndrome (CRS) is a potentially life-threatening complication of cancer immunotherapy with profound economic and clinical consequences. Older adults and underserved populations face unique challenges, including higher rates of comorbidities, limited access to specialized care, and greater financial strain, which exacerbate the burden of CRS. This study sought to evaluate the impact of CRS on key outcomes, including mortality, length of stay, hospitalization costs, and complications while addressing disparities in care delivery to these vulnerable populations. Methods: The National Inpatient Sample (NIS) database (2019–2021) was used to identify patients hospitalized with CRS using ICD-10 codes. Patients were stratified by age (< 65, 65–74, and ≥75 years). Baseline demographics, comorbidities, and hospital characteristics were compared using Pearson Chi-square tests for categorical variables and t-tests/ANOVA for continuous variables. Multivariate logistic regression estimated adjusted odds ratios (aORs) for in-hospital outcomes, accounting for age, comorbidities, and hospital characteristics. Results: Of 16,254 CRS patients analyzed, 59% were aged < 65 years, and 41% were ≥65 years. Males constituted 56.57% of the younger group and 56.12% of the older group (p = 0.78). Older patients had a higher proportion of White individuals (75.54% vs. 56.22%) and fewer Black, Hispanic, and Asian individuals (p < 0.01). In-hospital mortality was significantly higher in the ≥65 years age group, with an odds ratio (OR) of 1.78 (95% CI 1.64–1.94). Length of stay was shortest in the ≥75 years group (10.7 days), while total hospitalization costs peaked in the 65–74 years group at $400,754 (p = 0.03). Age-related complications included increased rates of sepsis, thrombocytopenia, anemia, and neutropenia in older patients, while severe outcomes such as CRS, deep vein thrombosis (DVT), and pulmonary embolism (PE) remained consistent across age groups. Conclusions: This study highlights the disproportionate burden of CRS on older adults, who demonstrated higher mortality and increased complications, including thrombocytopenia, anemia, and neutropenia. Despite shorter hospital stays, costs peaked in older patients. These findings underscore the need for tailored interventions to address age-related risks, optimize outcomes, and ensure equitable cancer care.