Comparison of Outcomes in Hospitalizations for Sepsis in Patients with Hematopoietic Stem Cell Transplantation: A Nationwide Analysis

Abstract

Background Sepsis with multiple organ failure is one of the frequent causes of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Patients with HSCT are at particular risk of developing sepsis due to their immunocompromised state. Studies have suggested that anywhere from 3.3% and 55% of such patients require Intensive Care admissions. Reports on outcomes of patients with sepsis with HSCT are limited. With our study we aim to study the demographics and outcomes of sepsis in adult patients with HSCT. Methods We analyzed hospitalizations for sepsis among adults in the Nationwide Inpatient Sample (NIS) available through Agency for Healthcare Research and Quality as a part of Healthcare Cost and Utilization Project. Patients were stratified into two groups based on the status of HSCT; using ICD-9 CM diagnostic codes. Descriptive statistics were represented as means/medians for continuous and as frequencies and percentages for categorical variables. A survey weighted multivariate regression analysis was used to adjust for confounders when calculating mortality. Results A total of 4501621 admissions with sepsis were identified from 2010-2014 and amongst these 4396 admissions also had underlying HSCT. Patients with history of HSCT admitted with sepsis was younger in age (55.96 years vs 67.06 years; p value=0.00), mostly males (60.56% vs 48.23%; p value=0.00) and increased comorbidities. They were more likely to be admitted to an urban teaching hospital. Patients with history of HSCT had increased mortality (17.82% patients vs 14.22% patients; p value=0.002) and increased costs per hospitalization ($ 83241 vs $65590; p value=0.0003). There was no significant difference in length of stay. When adjusted for confounders, patients admitted with sepsis with history of HSCT were found to have a 56% increased risk of mortality compared to general population. (Odds Ratio=1.565; 95% CI 1.283-1.911; p value=0.00). Conclusion Patients admitted with sepsis with history of HSCT are more likely to have poor outcome from sepsis than nontransplant patients. Clinicians should be vigilant about the screening and managing infections timely in patients with history of HSCT, to prevent poor outcomes from sepsis in patients with HSCT. Implementationof strategies that are known to improve outcomes in sepsis such as early administration of antibiotics and fluid resuscitation may be of particular importance in this high-risk population.