Sepsis in Acute Myeloid Leukemia (AML) patients: A 407,095-patient national inpatient sample study (2016-2022)

Abstract

Abstract Introduction Sepsis is a leading cause of morbidity and mortality in patients with cancer, but its impact in acute myeloid leukemia (AML) has not been well defined. We used the National Inpatient Sample (NIS) (2016–2022) to compare outcomes of hospitalized AML patients with versus without sepsis.Methods AML admissions were identified using ICD-10-CM codes from the NIS (2016–2022) and stratified by the presence or absence of sepsis. Patient demographics, comorbidities, hospital characteristics, and clinical outcomes were compared between AML patients with sepsis and those without. We performed multivariable regression to adjust for potential confounders. We used discharge weights (DISCWT) and survey design variables provided by NIS to produce nationally representative estimates. Outcomes included length of stay (LOS), total hospital charges, in-hospital mortality, and complications (acute renal failure, hepatic failure, disseminated intravascular coagulation, septic shock, and mechanical ventilation).Results We identified 407,095 AML admissions, of which 79,975 (19.6%) had sepsis. Patients with sepsis were more often male (56.5% vs 53.9%) and older; for example, 35.6% of sepsis patients were over age 70 versus 32.1% of non-sepsis patients (p<0.0001). The sepsis group had a higher comorbidity burden: 8.1% had a Charlson comorbidity index ≥7 compared to 5.7% in the non-sepsis group (p<0.0001). Comorbid neutropenia (35.5% vs 24.2%), coagulopathy (33.7% vs 27.2%), congestive heart failure (20.4% vs 12.8%), and chronic liver disease (10.0% vs 5.0%) were significantly more common in the sepsis group (all p<0.0001). Chronic lung disease (9.8% vs 8.0%) and chronic kidney disease (16.8% vs 13.5%) were also more frequent (p<0.0001). Length of stay was significantly longer for AML patients with sepsis (mean 16.9 vs 11.4 days); after adjustment, sepsis was associated with an additional ~6.0 days of hospitalization (95% confidence interval [CI] 5.65–6.44, p<0.0001). Total hospital charges were substantially higher in the sepsis group (mean $278,198 vs $152,766); the adjusted increase was $131,736 (95% CI 121,872–141,600, p<0.0001). In-hospital mortality was markedly elevated with sepsis: the adjusted odds ratio (aOR) for mortality was 5.97 (95% CI 5.64–6.32, p<0.0001) compared to AML without sepsis. Sepsis was associated with higher rates of life-threatening complications, including acute renal failure (42.5% vs 17.9%), hepatic failure (4.6% vs 0.6%), septic shock (45.1% vs 1.3%), disseminated intravascular coagulation (4.9% vs 2.2%), and need for mechanical ventilation (17.6% vs 2.2%) (all p<0.0001).Conclusion Among hospitalized AML patients, sepsis was associated with significantly higher mortality, longer hospital stay, higher costs, and more frequent life-threatening complications. These findings underscore the heavy clinical and economic burden of sepsis in AML and highlight the need for effective prevention and management strategies to improve outcomes in this high-risk population.