Impact of disseminated intravascular coagulation on in-hospital outcomes in patients with multiple myeloma: A nationwide analysis.

Abstract

e19557 Background: Disseminated intravascular coagulation (DIC) is an uncommon but severe hematologic complication in multiple myeloma (MM). Its impact on in-hospital mortality, clinical complications, and resource utilization remains poorly characterized at a national level. Thus, we aimed to compare outcomes of hospitalized MM patients with and without DIC using a National Inpatient Sample (NIS) database. Methods: We conducted a cross-sectional study using the NIS database to identify adult hospitalizations with a diagnosis of MM from 2018 to 2021. Patients were stratified by the presence or absence of DIC. Primary outcomes included in-hospital mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes included multiple in-hospital complications. Survey-weighted univariable and multivariable regression models were used to calculate adjusted odds ratios (aOR) and beta coefficients (β), adjusting for demographics and clinical covariates. Results: We identified a cohort of 467,530 adult MM hospitalizations from 2018 to 2021. Among these, 1,945 (0.4%) were complicated by DIC. In-hospital mortality was substantially higher with DIC than without DIC (49.0% vs 5.1%, p < 0.001); after multivariable adjustment, DIC remained an independent factor for increased odds of mortality (aOR 9.63 [7.53, 12.3], p < 0.001). Similarly, LOS was longer with DIC both before (median 9 vs 5 days, p < 0.001) and after adjusted analysis (β +5.4 days, p < 0.001). Inflation-adjusted THC were higher with DIC (median $158,749 vs $53,790, p < 0.001), with higher adjusted charges (β +$166,793, p < 0.001). The DIC group also had a significantly increased likelihood of non-home discharge (aOR 5.64, p < 0.001). A detailed comparison of in-hospital complications showed DIC group had higher rates of acute kidney injury (73% vs 35%; aOR 4.13 [3.24, 5.28]), renal replacement therapy need (28% vs 8.7%; aOR 3.76 [2.71, 5.22]), respiratory failure (57% vs 18%; aOR 4.25 [3.34, 5.41]), need for mechanical ventilation (42% vs 4.2%; aOR 7.70 [5.96, 9.94]), acute hepatic failure (21% vs 1.2%; aOR 13.7 [9.80, 19.3]), septic shock (40% vs 4.2%; aOR 4.79 [3.54, 6.48]), and cardiac arrest (9.8% vs 1.1%; aOR 4.41 [3.00–6.49]) (all p < 0.001). Additionally, patients with DIC also had higher odds of ischemic stroke (4.9% vs 1.7%; aOR 2.92 [1.81, 4.71]), hemorrhagic stroke (3.3% vs 0.8%; aOR 3.54 [0.81, 1.11]), and major bleeding (19% vs 5.0%; aOR 3.32 [2.50, 4.40]) (all p < 0.001). Pulmonary embolism and deep vein thrombosis were numerically higher but not statistically significant. Conclusions: MM patients with DIC experienced markedly worse inpatient outcomes and significantly greater resource utilization compared with those without DIC, highlighting DIC as a critical prognostic marker in MM hospitalizations and underscoring the need for early recognition and aggressive multidisciplinary management.