Health care utilization and outcomes of sepsis in HIV versus non-HIV patients with Burkitt Lymphoma: A nationwide analysis.

Abstract

e19561 Background: Burkitt lymphoma (BL) is an aggressive AIDS-defining malignancy, the incidence of which has not declined over the last 2 decades despite use of antiretroviral therapy. HIV-BL is more advanced at diagnosis compared to non-HIV-BL with increased risks of immunosuppressive chemotherapy (Lancet Hematology 2020;7(8):e594-e600). We attempted to explore and quantify the prevalence, outcomes and healthcare utilization of HIV-BL vs non-HIV-BL patients admitted with sepsis. Methods: Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was queried to identify all adult HIV and non-HIV admissions with BL between 2016–2018 with a primary diagnosis of sepsis. The groups were compared for demographic differences, 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, protein energy malnutrition (PEM) and history of bone-marrow/stem-cell transplant. Statistics were performed using the t-test, z-test and chi-square test. Results: A total of 2310 HIV-BL admissions comprising 205 (8.9%) with sepsis and 11,950 non-HIV-BL admissions with 865 (7.2%) with sepsis (p = 0.006) were identified. Compared to non-HIV cohort, HIV-BL patients were significantly younger (mean age 43.6 versus 55.3 years, p = 0.001) with few over 65 years old (2.4% vs 36%, p = 0.001). Both groups had similar gender ratio, but a higher number of HIV-BL admissions were African American (AA) (51.4% vs 4.9%, p = 0.001), on Medicaid (31.7% vs 15.6%, p < 0.0001), from lowest quartile income zip codes (p < 0.0001) and more likely to be treated at teaching hospitals (73.2% vs 54.9%, p < 0.0001). The overall inpatient mortality was 21.9% in HIV-BL vs 15.6% in non-HIV-BL (p = 0.02). HIV-BL reported increased mean LOS (9 vs 8 days, p = NS) and average $39,599 more in hospital charges for each HIV-BL admission compared to non-HIV-BL with sepsis (amounting to over $8 million over 3 years). The rates of anemia, neutropenia, TLS, AKI, SS, TLS and PEM were similar (p = NS) between the groups. Conclusions: Nationwide, HIV-BL patients had significantly higher rates of sepsis despite being significantly younger. They were also more likely to be AA from lower socioeconomic zip codes and more likely to be on Medicaid. The mean inpatient LOS and hospital charges, although not statistically significant, were higher in HIV-BL compared to their non-HIV counterparts. Also, the difference in total charges for all HIV-BL admissions amounted to over $8 million extra compared to non-HIV-BL in 3 years. These trends need to be evaluated in prospective studies to help identify interventions to improve clinical outcomes and healthcare utilization.