Non-variceal upper gastrointestinal bleeding in patients with acute leukemia.

Abstract

e19041 Background: Patients with acute leukemia are prone to various hemorrhages, most frequently due to thrombocytopenia from disease activity or chemotherapy. However, there is minimal literature evaluating non-variceal upper gastrointestinal bleeding (NVUGIB) in leukemia patients. This study evaluates the outcomes of NVUGIB in hospitalized acute leukemia patients. Methods: The United States Nationwide Inpatient Sample was used to extract hospitalization data of patients admitted between Jan 1st, 2016, to Dec 31st, 2019. Using International Classification of Diseases 10th revision codes, we identified adults with a discharge diagnosis of NVUGIB and a concomitant acute leukemia diagnosis, acute myelogenous leukemia and acute lymphoblastic leukemia. The control group included non-leukemia patients with NVUGIB. Primary outcome was in-hospital mortality. Secondary outcomes were length of stay (LOS), hospital charges, and effect of early esophagogastroduodenoscopy (EGD) within the first 24 hours of admission. Multivariate logistic regression was used to adjust for comorbidities and demographic variables. Results: A total of 1,208,885 discharges were identified with NVUGIB. Of those, 1019 had acute leukemia. Leukemia patients had higher mortality than the general population (12.5% vs. 3%, respectively; P <0.01). After adjusting for comorbidities and demographic variables, acute leukemia patients had significantly higher mortality (adjusted odds ratio [AOR] 3.75, 95%CI 2.37-5.94 P <0.01). Mean length of stay and hospital charges increased by 6.87 days (95%CI 3.99-9.75, P < 0.01) and 128,437$ (95%CI 68,633$-188,240$, P < 0.01), respectively, in the acute leukemia group. Additionally, acute leukemia patients who had an early EGD had significantly less mortality, length of stay, and hospital charges compared to delayed EGD as shown in the attached table. Conclusions: Acute leukemia patients admitted with NVUGIB have significantly higher in-hospital mortality and health care burden. Early EGD in these patients is associated with lower in-hospital mortality, shorter length of stay, and lower total hospital costs. However, given the retrospective nature of this study, we cannot determine that early EGD is a causal factor for the improved outcomes. Future prospective studies will be required in acute leukemia patients admitted with NVUGIB to further evaluate these findings.[Table: see text]