Abstract
Purpose: Our objective was to determine the risk factors for inpatient mortality of pediatric patients diagnosed with lymphoma through the utilization of a large national pediatric database.Methods: This cross-sectional study uses data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) for the year of 2012 to estimate the risk factors for inpatient mortality for pediatric patients diagnosed with lymphoma. All patients diagnosed with lymphoma between the ages of one and 18 years were included. Chi-square test was used to analyze categorical variables. Independent t-test was used to analyze continuous variables.Results: A total of 2,908 study subjects with lymphoma were analyzed. Of those, 56.1% were male and the average age was three years old. Total inpatient mortality was 1.2% or 34 patients. We found that patients with four or more chronic conditions were much more likely to die while hospitalized (p < 0.0001). In addition, we also saw that patients with median household incomes below $47,999 dollars (p = 0.05) having a need for a major procedure (p = 0.008) were associated with inpatient mortality. Congestive heart failure, renal failure, coagulopathy, metastatic disease, and electrolyte abnormalities were all found to be associated with inpatient mortality.Conclusions: Pediatric lymphoma mortality in children is not only influenced by their medical condition but also by their socioeconomic condition as well.
Highlights
Lymphoma is the third most frequent type of cancer in children, making up 11.5% of all childhood malignancies [1]
We saw that patients with median household incomes below $47,999 dollars were more predisposed to inpatient mortality compared to those making $48,000 and above (p = 0.05)
This is a retrospective study, and we are unable to determine how the comorbidities were managed and whether more effective management of the specific risk factors led to better survival. This relationship can be explored in future studies to develop better plans to manage pediatric lymphoma patients with comorbidities. In this national children’s database study, we found that pediatric lymphoma mortality in children is influenced by their medical condition and by their socioeconomic condition as well
Summary
Lymphoma is the third most frequent type of cancer in children, making up 11.5% of all childhood malignancies [1]. The five-year survival rate of HL has increased from 87% from 1975-1979 to 97% from 2003-2009. Survival rates for NHL increased from 47% to 85% during the same time period [2]. In NHL, factors that affect survival include response to therapy, stage and site of disease at diagnosis, and genetic abnormalities [7,8,9,10]. A randomized study of high-risk NHL involving the CNS and BM reported a 30% event-free survival (EFS) in patients who did not respond to initial treatments compared to 97% in those who did. The same study reported that patients with BM involvement only and CNS involvement only had a four year EFS of 88% and 82%, respectively. In patients with both CNS and BM involvement, the EFS drops to 61% [7]
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