Predictors of mortality in patients with HIV and tumor lysis syndrome.

Abstract

e19038 Background: Patients with Human Immunodeficiency Virus (HIV) are at increased risk for developing cancer, and malignancy represents an important cause of death in this population. Tumor lysis syndrome (TLS) has been noted a predictor of early death in patients with HIV and leukemia and lymphomas, however, overall mortality in patients with HIV who develop TLS is poorly characterized. We evaluated clinical characteristics and in-hospital outcomes among patients with TLS, stratified by HIV status and malignancy subtype. Methods: We performed a retrospective cohort study of adult hospitalizations with TLS using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) from 2016-2019. The analytic cohort consisted of adult patients hospitalized with a diagnosis of TLS. The primary endpoint was in-hospital mortality. Multivariable logistic regression adjusted for demographics, comorbidities, markers of illness severity, and malignancy subtype. Results: A total of 49,395 patients with TLS were included in the study. HIV was associated with higher in-hospital mortality compared to patients without HIV (30.6% vs 23.6%; p<0.001). The final cohort included 865 patients with concurrent TLS and HIV. The median age was 47 years. 740 patients had lymphoma (85.5%), and 75 patients had leukemia (8.7%). 190 patients had an opportunistic infections (OI) (22%), and 65 patients had an OI associated with a CD4 count < 50 (7.5%). In adjusted models, HL (aOR 3.7; p=0.002) was independently associated with increased mortality. Acute kidney injury, acute respiratory failure, vasopressor use, mechanical ventilation, septic shock, and CD4 < 50 phenotype were the strongest predictors of mortality (all p<0.01). Arrhythmia, MI, pulmonary embolism, and stroke were not associated with increased mortality. Conclusions: TLS is a known risk factor for early mortality in patients with HIV-associated NHL. Our data suggests that HL is most strongly associated with increased mortality in patients with TLS and HIV. Patients with HIV are at increased risk of developing HL, and HL is known to cause an immunosuppressive state. Sepsis and septic shock were associated with increased mortality. CD50 phenotype was independently associated with increased odds of in-hospital mortality, though the broader category of OI were not, suggesting that mortality in TLS with HIV is driven by advanced immunosuppression rather than opportunistic infections in general. Mortality in patients with HL, HIV, and TLS is an area of further investigation. Cancer Subtype Number of patients (N) Deaths Mortality P-value Leukemia 75 20 26.7% p =.435 Acute Myeloid Leukemia (AML) 30 15 50.0% p =.019 Lymphoma 740 225 30.4% p =. 721 Hodgkin’s Lymphoma (HL) 45 20 44.4% p =.039 Non-Hodgkin’s Lymphoma (NHL) 700 210 30.0% p =.403 Solid Tumors 140 55 39.3% p =.015 Kaposi’s sarcoma 45 20 44.4% p =.039 Secondary malignant neoplasm of the liver 45 20 44.4% p = .039 Total 865 265 30.6%