A nationwide analysis of healthcare utilization and outcomes of sepsis in HIV versus non-HIV patients with Hodgkin lymphoma.

Abstract

e19520 Background: Hodgkin lymphoma (HL) is a non-AIDS defining malignancy with a high relative risk in people with HIV compared to general population. The incidence is also higher with those with higher CD4 counts. In the US, reported mortality in HIV-HL is similar to non-HIV-HL per clinical trials, but higher in studies outside clinical trials. Sepsis is a common complication during the course of HL treatment. We attempted to explore outcomes and healthcare utilization of HIV vs Non-HIV-HL patients admitted with sepsis. Methods: We identified all adult patients with HL admitted between 2016 – 2018 from Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, with a primary diagnosis of sepsis. Patients with and without HIV were identified and compared for demographic differences and primary outcomes of inpatient mortality, length of stay (LOS) and hospital charges. Secondary outcomes studied included rates of septic shock (SS), acidosis, Acute Kidney Injury (AKI), Tumor Lysis Syndrome (TLS) pancytopenia, anemia, neutropenia and protein energy malnutrition (PEM). Statistics were performed using the t-test, z-test and chi-square test. Results: We identified a total of 1140 HIV-HL and 43,120 non-HIV-HL admissions of which sepsis was a principal diagnosis in 235 (20.6%) and 5390 (12.5%) admissions respectively (p < 0.0001). Compared to non-HIV-HL, HIV-HL patients were significantly younger (47.1 vs 56.8 years, p < 0.001), more likely to be men (79% vs 57%, p < 0.001), African American (47% vs 13%) and Hispanic (23% vs 14%) (p < 0.001), more likely to be on Medicaid (34% vs 18%, p < 0.001) and from low-income zip-codes (p < 0.0001). The overall inpatient mortality was lower in HIV-HL (10.6%) vs non-HIV-HL (15.8%) (p < 0.05). However, HIV-HL was associated with increased mean LOS (12.5 vs 9.1 days, p < 0.05) and higher mean hospital charges, a $39,082 difference, for each admission of HIV-HL compared to non-HIV-HL (amounting to over $9 million over 3 years). HIV-HL also had significantly high Charlson Comorbidity index of > 10 (p < 0.05) and significantly higher rates of TLS, acidosis, AKI and PEM (all p < 0.05). All other outcomes were non-significant. Conclusions: Nationwide, HIV-HL inpatients were younger minorities from lower socio-economic status zip codes and more likely to be on Medicaid compared to non-HIV-HL cohort. HIV-HL had significantly higher rates of sepsis compared to non-HIV-HL. However, despite high rates of sepsis in HIV-HL, these patients had significantly lower mortality than non-HIV-HL group but significantly higher inpatient LOS and higher hospital charges, likely related to higher comorbidity and complication burden. Prospective studies are needed to clarify these findings and identify interventions to improve secondary outcomes and healthcare utilization in HIV-HL patients.