Predictors of in-hospital mortality in chemotherapy-associated cardiomyopathy: A national inpatient sample analysis (2018-2022).

Abstract

e24025 Background: Chemotherapy-associated cardiomyopathy (CAC) is a recognized complication of cancer treatment, yet predictors of in-hospital mortality remain poorly characterized at the national level. We aimed to identify baseline clinical factors associated with mortality in hospitalized CAC patients. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (2018-2022). Adults with cardiomyopathy (ICD-10: I420, I427, I428, I429) and chemotherapy exposure or cancer history (Z5111, Z5112, Z85) were included. Patients with ischemic, hypertensive, alcoholic, or postpartum cardiomyopathy were excluded. Survey-weighted multivariate logistic regression identified independent predictors of in-hospital mortality. Model discrimination was assessed using area under the receiver operating characteristic curve (AUC). Results: We identified 14,896 hospitalizations (weighted national estimate: 74,480). Mean age was 70.7 years and in-hospital mortality was 0.74% (n = 110). On multivariate analysis, independent predictors of mortality included metastatic cancer (aOR 4.01, 95% CI 2.31-6.96, p < 0.001), weight loss (aOR 3.74, 95% CI 2.28-6.14, p < 0.001), renal disease (aOR 2.51, 95% CI 1.67-3.76, p < 0.001), liver disease (aOR 2.26, 95% CI 1.12-4.56, p = 0.024), and increasing age (aOR 1.04 per year, 95% CI 1.02-1.07, p < 0.001). Female sex, coagulopathy, fluid/electrolyte disorders, complicated diabetes, and hypertension were not significantly associated with mortality. The prediction model demonstrated fair discrimination (AUC 0.746, 95% CI 0.700-0.792). Conclusions: In this nationally representative analysis of CAC hospitalizations, metastatic cancer, weight loss, renal disease, liver disease, and older age were independent predictors of in-hospital mortality. These findings may help identify high-risk patients requiring closer monitoring during hospitalization. Independent predictors of mortality. Predictor aOR (95% CI) P-value Significance AGE 1.04 (1.02-1.07) <0.001 *** female 0.90 (0.61-1.33) 0.611 Metastasis 4.01 (2.31-6.96) <0.001 *** renal composite 2.51 (1.67-3.76) <0.001 *** weight loss 3.74 (2.28-6.14) <0.001 *** coagulopathy 1.02 (0.51-2.05) 0.963 liver disease 2.26 (1.12-4.56) 0.024 * fluid electrolyte 1.07 (0.72-1.60) 0.724 diabetes 0.94 (0.53-1.67) 0.828 hypertension 0.67 (0.44-1.03) 0.069