Septicemia in acute lymphoblastic leukemia: Disparities in incidence, resource utilization, and mortality between pediatric and adult populations.

Abstract

e18510 Background: Acute lymphoblastic leukemia (ALL) in adults has substantially worse outcomes than pediatric ALL, with cure rates of 40-50% versus 80-90% respectively. Both groups are at high risk for infection during treatment, particularly during prolonged neutropenia. We aim to analyze age-based differences in sepsis incidence, clinical profiles, and outcomes in ALL patients. Methods: We identified active ALL admissions via the National Inpatient Sample (NIS) between 2016 and 2022, excluding patients in remission and those with COVID-19. Patients were stratified as adults (≥18 years) and children (<18 years). We evaluated the incidence of septicemia and compared demographics, vasopressor use, palliative care encounters, all-cause mortality, length of stay, and total hospital charges between adults and children with ALL-associated septicemia. Results: Among 254,380 patients with active ALL (108,570 children and 145,810 adults), septicemia incidence was significantly higher in adults (14.12% vs 5.77%, p<0.001). The study included 26,855 ALL patients with septicemia (pediatric: 6,265; adult: 20,590). Adults were more likely to be covered by Medicare (28.3% vs 0.2%, p<0.001) while children predominantly had Medicaid coverage (50.8% vs 25.4%, p<0.001). Adults were more frequently admitted to rural hospitals (2.0% vs 0.5%) and urban non-teaching facilities (8.4% vs 1.1%), while pediatric patients were more often treated at urban teaching centers (98.4% vs 89.6%, p<0.001). Race distribution differed significantly (p<0.001), with adults having higher proportions of White (49.4% vs 43.0%) and Black patients (8.7% vs 6.9%) while pediatric patients had more Hispanic patients (39.2% vs 30.7%). Sex distribution was similar (44.2% vs 44.4% female, p=0.938). Weekend admission rates and median household income showed no meaningful differences. Adults had higher rates of vasopressor use (7.9% vs 2.7%, p<0.001) and palliative care encounters (14.6% vs 4.7%, p<0.001). Pediatric patients had longer hospital length of stay (24.6 vs 16.9 days, p<0.001) and higher total charges ($610,623 vs $337,771, p<0.001). Pediatric patients had significantly lower mortality (9.26% vs 17.03%, p<0.001), with adults having 1.60 times the odds of mortality (aOR 1.60, 95% CI 1.27-2.01, p<0.001). Conclusions: Our study revealed that adults with ALL had higher incidence of sepsis and higher odds of mortality when compared with children with ALL. Despite longer hospital stays, the pediatric cohort had favorable outcomes signifying differences in biology, treatment approaches and access to specialized leukemia care warranting strategic steps to intervene.