Outcomes of invasive pulmonary aspergillosis in hospitalized hematopoietic stem cell transplantation recipients: A National Readmission Database study.

Abstract

e19051 Background: Hematopoietic Stem Cell Transplant (HSCT) is well established method of treatment for hematologic malignancies and certain autoimmune and congenital conditions. HSCT is associated with compromise in the host immune system and increases risk of various infection in these patients, such as Invasive Pulmonary Aspergillosis (IPA). Methods: A retrospective study of a nationally representative cohort of hospital admissions was conducted from January 1, 2013 to December 31, 2018. Data was collected from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD) between 2013 and 2018. We used the International Classification of Diseases, 10th revision (ICD–10), and 9th revision (ICD-9) diagnostic codes to identify patients with IPA and HSCT. All adult patients ≥18 years were included in the study. Our study's primary objective was to assess the relationship between IPA on in-hospital mortality and 30-day readmission among patients undergoing HSCT. A secondary objective was to examine potential differences in complications between HSCT with IPA and HSCT without IPA. The absolute yearly mortality and rate of IPA for HSCT patients from 2013 to 2018 were also calculated. We used survey statistics to calculate weighted analysis and compared with Pearson’s chi-square test for categorical variables and t-test for the continuous variables. We calculated the odds ratio and 95% confidence interval in multivariate logistic regression for association of mortality among patients with IPA adjusted for model 1 variables including age, sex, smoking status, insurance type, and comorbid conditions. All p-values were 2 sided, with a significance threshold of p < 0.05. Results: A total of 90,451 index hospitalizations for HSCT were identified for the years 2013-2018 in the NRD with the 89,331 index hospitalizations for HSCT without IPA, and 1,092 index hospitalizations for HSCT-IPA. The in-hospital mortality for HSCT-IPA was higher as compared to HSCT without IPA (18.3% vs 4.2%; p < 0.001). HSCT-IPA had a significantly higher 30-day readmission rate (36.2%) than HSCT without IPA (24.0%). The HSCT-IPA group had higher multi-organ complications including atrial fibrillation (AF) (13.6% vs 8.3%; p < 0.007), acute kidney injury (AKI) (54.8% vs 22.0%; p < 0.001), respiratory failure (51.3% vs 13.5%, p < 0.001), pneumonia (65.4% vs 19.4%, p < 0.001), sepsis (38.2% vs 18.5%, p-value < 0.001), septic shock (16.1% vs 5.1%, p < 0.001), need for mechanical ventilation (21.1% vs 5.1% p < 0.001), non-invasive positive pressure ventilation (4.9% vs 2.5%, p < 0.001), and intensive-care unit admission (21.8% vs 6.1% p < 0.001). Conclusions: IPA is rare but fatal complication associated with HSCT with higher in-hospital mortality, 30-day readmission, and complications due to multiorgan failure.