Impact of graft-versus-host disease on mortality, length of stay, and hospitalization costs in bone marrow transplant patients: A retrospective analysis using the 2021 NIS database.

Abstract

e18554 Background: Graft-versus-host disease (GVHD) is a significant complication of bone marrow transplantation (BMT), influencing patient outcomes, length of stay (LOS), and hospitalization costs. This study evaluates the prevalence of GVHD in hospitalized BMT patients and its impact on outcomes using the 2021 National Inpatient Sample (NIS) database. Methods: We conducted a retrospective analysis of the NIS 2021 dataset. Patients who underwent BMT and patient’s who developed GVHD were identified using the appropriate ICD-10 codes. Survey-weighted descriptive statistics were used to analyze patient demographics, mortality rates, LOS, and total hospitalization charges (TOTCHG). Multivariable logistic and linear regression models evaluated GVHD’s impact on outcomes, adjusting for age, sex, race, income quartiles, Charlson comorbidity index (CCI), hospital region, teaching status, and bed size. The top principal diagnoses were ranked by weighted counts. Results: A total of 20,165 weighted BMT hospitalizations were analyzed, of which 10.9% (95% CI: 9.8%-12.1%) were associated with GVHD. GVHD patients had a significantly higher mortality rate compared to non-GVHD patients (6.4% vs. 4.5%, p=0.04), longer LOS (10.7 vs. 7.2 days, p<0.001) and GVHD patients had significantly higher mean hospitalization charges ($235,485 vs. $113,706). Adjusted regression showed GVHD was associated with a 50% higher odds of mortality (aOR: 1.50, 95% CI: 1.03-2.31, p=0.031), 3.3 additional hospitalization days (95% CI: 1.70-4.87, p<0.001), and $112,376 higher total charges (95% CI: $54,212-$170,539, p<0.001). Significant adjusted predictors of mortality included age (OR = 1.01, p = 0.009) and Charlson Comorbidity Index (OR = 1.47, p < 0.001). Length of stay was significantly influenced by CCI (0.51 days, p = 0.022), and teaching hospital status (1.76 days, p < 0.001). Hospital charges were significantly higher with CCI ($13,646.94, p = 0.023), and at teaching hospitals ($45,054.57, p < 0.001). The most common primary diagnoses among BMT patients with GVHD included septicemia (650 cases), pneumonia (202 cases), acute kidney failure (320 patients) and COVID-19 (130 cases). Conclusions: GVHD significantly exacerbates the clinical and economic burden of BMT, leading to increased mortality, LOS, and healthcare costs. Age, Charlson Comorbidity Index, and teaching hospital status were also significant predictors of mortality, length of stay, and hospital charges. The most common primary diagnoses among GVHD patients included septicemia, pneumonia, acute kidney failure, and COVID-19, underscoring the complexity and resource-intensive care required for this population. These findings emphasize the need to focus on early detection strategies and innovative treatment modalities to mitigate the impact of GVHD in BMT patients.