Inpatient Mortality Research Articles

Patients with atrial fibrillation and diabetes mellitus affected by nonalcoholic fatty liver disease have a greater risk of mortality and worse clinical outcomes

Background Nonalcoholic fatty liver disease (NAFLD) is associated with several adverse clinical outcomes. In this study, we assessed the association between NAFLD and several clinical outcome measures in patients with diabetes mellitus (DM) and atrial fibrillation (AF). Methods We queried the National Inpatient Sample (NIS) between 2016 and 2019 for adult patients who were hospitalized with DM and AF. NAFLD was the independent variable. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), invasive mechanical ventilation, length of stay, and total hospital charges. A multivariable logistic regression model was used to estimate odds ratios with a 95% confidence interval (CI) and a P value of less than 0.05 was considered significant. Results There were 6 723 293 hospitalizations with AF and DM and 253 639 (3.7%) had NAFLD. NAFLD and non-NAFLD cohorts had a mean age of 70.4 vs. 73.8 years, respectively. Overall, 55.6% were male and 73.8% were White. NAFLD was found to be significantly associated with in-hospital mortality [adjusted odds ratio (AOR), 4.2; 95% CI, 4.08–4.32], cardiogenic shock (AOR, 4.78; 95% CI, 4.59–4.98), cardiac arrest (AOR, 3.43; 95% CI, 3.27–3.59), GIB (AOR, 1.92; 95% CI, 1.86–1.98), length of stay, and total hospital charges. Conclusion In patients with AF and DM patients, the presence of NAFLD was associated with significantly worse clinical outcomes and higher resource utilization. Adverse cardiovascular events were common as well as GIB. Screening and prevention strategies modifying the risk and disease severity of NAFLD are needed.

Atrial fibrillation inpatient management patterns and clinical outcomes during the conflict in Syria: An observational cohort study.

Atrial fibrillation (AF) is the most common sustained arrhythmia worldwide. However, there is no data on AF inpatient management strategies and clinical outcomes in Syria. The study aims were to review the inpatient management of patients with AF and assess cardiovascular (CV) mortality in a tertiary cardiology centre in Latakia, Syria. A single-centre retrospective observational cohort study was conducted at Tishreen's University Hospital, Latakia, Syria, from June 2021 to June 2023. Patients ≥16years of age presenting and being treated for AF as the primary diagnosis with or without a thromboembolic event were included. Medical records were examined for patients' demographics, laboratory results, treatment plans and inpatient details. Studied outcomes include inpatient all-cause and CV mortality, ischemic and bleeding events, and conversion to sinus rhythm (SR). The study included 596 patients. The median age was 58, and 61% were males. 121 patients (20.3%) were known to have AF. A rhythm control strategy was pursued in 39% of patients. Ischemic and bleeding events occurred in 62 (11%) and 12 (2%), respectively. CV and all-cause mortality occurred in 28 (4.7%) and 31 patients (5%), respectively. The presence of valvular heart disease (VHD) (adjusted odds ratio (aOR) = 9.1, 95% confidence interval (CI): 1.7 to 55.1, p < .001), thyroid disease (aOR: 9.7, 95% CI = 1.2 to 91.6, p < .001) and chronic obstructive pulmonary disease (COPD) (aOR: 82, 95% CI: 12.7 to 71, p < .001) were independent risk factors of increased CV inpatient mortality. Syrian inpatients admitted with AF in Latakia are relatively younger than those in other countries. Active thyroid disease, COPD and VHD were independent risk factors of inpatient CV mortality with AF.

Steroid therapy in acute exacerbation of fibrotic interstitial lung disease.

Evidence for the benefit of steroid therapy in acute exacerbations (AEs) of idiopathic pulmonary fibrosis (IPF) is limited; however, they remain a cornerstone of management in other fibrotic interstitial lung diseases. This retrospective observational study assesses the effect of steroid treatment on in-hospital mortality in patients with acute exacerbation of fibrotic interstitial lung disease (AE-FILD) including IPF and non-IPF ILDs. AE-FILD cases over a 10-year period were filtered using a code-based algorithm followed by individual case evaluation. Binary logistic regression analysis was used to assess the relationship between corticosteroid treatment (defined as ≥0.5 mg/kg/day of prednisolone-equivalent for ≥3 days within the first 72 h of admission) and in-hospital mortality or need for lung transplantation. Secondary outcomes included readmission, overall survival, requirement for domiciliary oxygen and rehabilitation. Across two centres a total of 107 AE-FILD subjects were included, of which 46 patients (43%) received acute steroid treatment. The steroid cohort was of younger age with fewer comorbidities but had higher oxygen requirements. Pre-admission FVC and DLCO, distribution of diagnoses and smoking history were similar. The mean steroid treatment dose was 4.59 mg/kg/day. Steroid use appeared to be associated with increased risk of inpatient mortality or transplantation (OR 4.11; 95% CI 1.00-16.83; p = 0.049). In the steroid group, there appeared to be a reduced risk of all-cause mortality in non-IPF patients (HR 0.21; 95% CI 0.04-0.96; p = 0.04) compared to their IPF counterparts. Median survival was reduced in the steroid group (221 vs. 520.5 days) with increased risk of all-cause mortality (HR 3.25; 95% CI 1.56-6.77; p < 0.01). In this two-centre retrospective study of 107 patients, AE-FILD demonstrates a high risk of mortality, at a level similar to that seen for AE-IPF, despite steroid treatment. Clinicians should consider other precipitating factors for exacerbations and use steroids judiciously. Further prospective trials are needed to determine the role of corticosteroids in AE-FILD.

Inpatient outcomes of patients with new solid tumors admitted to a comprehensive cancer center.

e23056 Background: Hospitalized cancer patients demonstrate multiple challenges including management of acute illnesses, establishment of the cancer diagnosis, creation of a goal concordant care plan, and post-hospital disposition. Yet, there has been limited research regarding characteristics and outcomes of new to hospital oncology patients. Methods: We performed a retrospective chart review of patients with suspicion or confirmed solid tumor cancer diagnosis who were admitted without an established MD Anderson Cancer Center oncologist. We assessed length of stay, ICU utilization, 30-day readmission rate, inpatient mortality, and discharge disposition. We compared the results to our group’s established oncology patients. Statistical analysis was performed using Chi-squared testing. Results: Between November 2022 and January 2023, 201 unique new patients were reviewed out of 1635 admissions. Of those 103 (51.2%) were males, median age of 60 (range: 22-79), White including Hispanics 118 (59%), African Americans 46 (23%), others 33 (18%). Of the study population, 88 (43.8%) did not have a confirmed cancer diagnosis, of which we established a cancer diagnosis in 68 (77.3%) and ruled out cancer in 8 (4%). Of the 113 (56.2%) diagnosed at outside facilities, 63 (55.8%) were treatment naive and 22 (19.4%) had their cancer diagnosis revised. Of 175 patients which had staging information, 150 (85.7%) were stage 4. During the index admission, 45 (22.4%) patients had cancer-directed therapy. The average and geometric mean length of stay (days) for new patients was 12.1 and 8.8, respectively, compared to the established group of 8.2 and 6.1 (p &lt; 0.001). Inpatient mortality was higher in new patients (10.5% vs 6.8%, p &lt; 0.001) and they were more likely to be referred to hospice services (17.4% vs 8.3%, p &lt; 0.001). Furthermore, hospice referral was higher in the unestablished, previously treated group compared to treatment naive patients (28% vs 13.9%, p = 0.003), however inpatient mortality was similar (12% vs 9.9%, p = 0.63). ICU stay, 30-day readmission rate, discharge to home vs placement were similar in new and established patients (Table 1). Conclusions: Admitted new oncology patients typically present with advanced disease and had longer length of stay, mortality rates, and hospice referrals compared to established patients. Further research is needed to identify and improve care barriers to new inpatients, focusing on improving workflow process and timely goal concordant care discussions. [Table: see text]

Effect of palliative care on economic burden in lung cancer admissions: Insights from the NIS database.

12081 Background: Lung cancer (LC) remains the leading cause of cancer mortality globally, presenting substantial challenges in symptom management and quality of life (QoL) for affected patients. Despite the crucial role of palliative care (PC) in alleviating suffering and enhancing QoL, its integration into LC treatment is inconsistent, attributed to healthcare provider perceptions and systemic barriers. This study examines the utilization of PC consultations in LC admissions using the National Inpatient Sample (NIS) database, seeking to identify patterns of use and opportunities for improved care integration. Methods: The study queried the NIS database from 2016 to 2020 for adult hospitalized patients with a primary diagnosis of LC using ICD-10 codes. The primary outcome examined was the impact of PC consultations on length of stay (LOS), total hospital charges (THC), and healthcare utilization, with inpatient mortality as a secondary outcome. Baseline characteristics were assessed using t-tests and chi-square tests, while multivariable logistic regression analysis adjusted for age, gender, race, Charlson index, insurance type, and household income was employed to evaluate the outcomes. Results: Among 584,055 LC patients, 50.4% was female and 14.6% had a PC consult. These patients were typically older (68.4 vs. 70.6 years, p &lt;0.001), more likely to be male (51.1% vs. 49.3%, p &lt; 0.001) and African American (13.3% vs. 11.9% p &lt; 0.001), and had Medicaid coverage (11.1% vs. 9.7%, p &lt; 0.001) compared to their counterparts . PC was more frequently consulted in non-teaching hospitals (16.3% vs 14.1%, p &lt; 0.001). Patients with PC consults also had a higher Charlson Comorbidity index 6.4 vs. 4.9 (p &lt; 0.001). The overall inpatient mortality rate was 7.4%, with a significantly higher rate in patients with PC (32%) versus without (3.2%) (p &lt; 0.001). While PC was associated with a longer LOS (7.6 vs. 5.9 days, p &lt; 0.001), it resulted in lower THC ($74,399 vs. $84,233, adjusted difference: $6,874 p &lt; 0.0001) and increased discharges with home health care and to nursing homes. Conclusions: PC consultations in LC patients are associated with reduced THC despite a slight increase in LOS. This finding emphasizes the economic and therapeutic value of PC in the treatment of LC, advocating for its earlier and broader integration. By addressing both symptom management and healthcare costs, palliative care can play a significant role in enhancing the comprehensive care of lung cancer patients, highlighting the need for overcoming existing barriers to its adoption. [Table: see text]

Comparison of infective endocarditis in patients with and without malignancy: A propensity score matched analysis.

e24030 Background: Cancer patients are at a higher risk of infective endocarditis (IE) due to immunosuppressed state, indwelling catheters and recurrent infections. Due to the clinical scenario being relatively uncommon, there is lack of real-world data on prevalence, trends and outcomes of IE in cancer patients. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions ≥18 years old with a principal diagnosis of IE with and without a cancer diagnosis using International Classification of Diseases Tenth Revision (ICD-10) codes. Propensity score matching was performed to balance hospital characteristics, patient demographics and comorbidities between the two groups. Univariate logistic regression was performed in the balanced cohorts. The primary outcome was inpatient mortality. Analysis was performed using STATA-MP, version 14.2. Results: A total of 70,225 admissions for IE were identified between 2016-2020, of which 2,294 (3.27%) had a history or active cancer. The annual number of admissions for IE did not show a significant change (p trend = 0.56); however, the proportion of IE patients with cancer doubled from 2.33% to 4.61% (p trend &lt; 0.01) over the study period. After propensity score matching, there was no significant difference in in-hospital mortality (odds ratio [OR] 1.30, 95% CI 0.79-2.16, p = 0.31) between IE patients with and without cancer. Cohort with cancer had lower odds of experiencing respiratory failure (OR 0.52, 95% CI 0.33-0.83, p &lt; 0.01) and stroke (OR 0.35, 95% CI 0.25-0.49, p &lt; 0.01), although venous thromboembolism was more common in cohort with cancer (OR 3.03, 95% CI 1.76-5.21, p &lt; 0.01). There was no difference in acute kidney injury or shock between the two groups. Cohort with cancer was less likely to undergo valve replacement surgery (OR 0.42, 95% CI 0.31-1.24, p &lt; 0.01). The median length of stay (11 days vs 14 days, p &lt; 0.01) and hospital charges ($70,698 vs $86,763, p &lt; 0.01) were higher in the cohort without cancer. Conclusions: Underlying cancer was seen in growing proportion of admissions for IE over the study period. The pattern of complications was different between patients with and without cancer, which underscores the importance of cancer history in management of IE. Although there was no difference in mortality between patients with and without cancer, patients with cancer were less likely to undergo valve replacement surgery during the admission. Further research is needed to explore the specific factors influencing treatment decisions and long-term outcomes in cancer patients with IE.

Prevalence and clinical outcomes of acute heart failure among patients with mediastinal radiation exposure: A propensity score matched analysis.

e24029 Background: Radiation therapy (RT) for malignancy in mediastinal region is associated with radiation-induced heart disease in subsequent years, including coronary, valvular, myocardial, pericardial and conduction system disease. Although increased risk of diastolic heart failure (DHF) has been established, there is limited data on the prevalence, trends and outcomes of acute DHF admissions in patients with prior mediastinal RT. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions ≥18 years old with a principal diagnosis of acute DHF with and without history of RT for mediastinal cancer using International Classification of Diseases Tenth Revision (ICD-10) codes. Propensity score matching was performed to balance hospital characteristics, patient demographics and comorbidities between the two groups. Univariate logistic regression was performed in the balanced cohorts. The primary outcome was inpatient mortality. Analysis was performed using STATA-MP, version 14.2. Results: A total of 2,356,025 admissions for acute DHF were identified between 2016 to 2020, of which 15,435 (0.65%) had prior mediastinal RT. During the study period, we found an increasing trend in the number of admissions for acute DHF (p trend &lt; 0.01) along with an increased proportion of patients with prior mediastinal RT. (0.55% in 2016 to 0.78% in 2020, p trend &lt; 0.01). After propensity score matching, there was no difference in in-hospital mortality (odds ratio [OR] 1.12, 95% CI 0.79-1.58, p = 0.537), or complications such as cardiogenic shock, respiratory failure, stroke, venous thromboembolism, or acute kidney injury between the two cohorts. There was no difference in length of stay, however, cohort with history of mediastinal RT had higher hospital charges ($26,634 vs $31,511, p &lt; 0.01). Conclusions: Exposure to mediastinal RT represents a minority but growing number of hospital admission with DHF. The mortality and complications of RT associated DHF does not differ significantly from those with traditional etiologies of DHF.

Impact of multiple myeloma on outcomes of acute myocardial infarction: A propensity score matched analysis.

e24027 Background: Patients with multiple myeloma (MM) are at increased risk of cardiovascular events secondary to its complications and adverse effects of pharmacotherapy. However, data on in-hospital outcomes of MM on acute myocardial infarction (AMI) is limited due to the clinical scenario being relatively uncommon. Thus, we conducted a retrospective study to investigate the in-hospital outcomes and resource utilization of AMI admissions in MM patients. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions ≥18 years old with a principal diagnosis of AMI with and without co-morbid MM using International Classification of Diseases Tenth Revision (ICD-10) codes. Propensity score matching was performed to balance hospital characteristics, patient demographics and comorbidities between the two groups. Univariate logistic regression was performed in the balanced cohorts. The primary outcome was inpatient mortality. Analysis was performed using STATA-MP, version 14.2. Results: A total of 3,191,049 hospitalizations for AMI were identified between 2016 and 2020, of which 6,565 (0.21%) had co-morbid MM. After propensity score matching, compared to those without MM, admissions for AMI with MM had higher odds ratio (OR) of mortality (OR 1.51, 95% CI 1.1-2.08, p = 0.01). Similar rates of complications such as respiratory failure, cardiogenic shock, stroke and vascular complications were seen between the two cohorts. However, acute kidney injury was more common in patients with MM (OR 1.81, 95% CI 1.52-2.14, p &lt; 0.01). Compared to those without MM, admissions for AMI with MM were less likely to undergo coronary angiogram (OR 0.73, 95% 0.63-0.86, p &lt; 0.01), percutaneous coronary intervention (PCI) (OR 0.71, 95% CI 0.60-0.84, p &lt; 0.01) or coronary artery bypass grafting (CABG) (OR 0.52, 95% CI 0.37-0.71, p &lt; 0.01). There was no difference in the length of stay but median hospitalization charges were higher in the cohort with MM ($ 54,125 vs $ 58,493, p &lt; 0.01). Conclusions: Despite similar complication rates, patients with multiple myeloma (MM) who presented with acute myocardial infarction (AMI) experienced higher in-hospital mortality compared to those without MM. One plausible explanation is that patients with MM were less likely to undergo definitive management procedures such as coronary angiogram, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG) during their admission, as observed in our study. Alternatively, MM might independently predict worse outcomes for AMI. Further research is needed to understand the interplay between AMI and MM, as well as to identify factors contributing to disparities in outcomes and intervention rates between patients with and without MM.

Clinical outcomes and resource utilization in patients with multiple myeloma admitted with gastrointestinal bleeding.

e19522 Background: In multiple myeloma (MM) patients, GIB can be due to factors such as abnormal proteins affecting the GI tract, coagulation issues, or secondary conditions like amyloidosis. There's limited scientific evidence examining outcomes among patients presenting with both GIB and MM. Thus, our objective was to assess clinical outcomes in this specific population. Methods: We accessed the National Inpatient Sample from 2017-2020 to identify adult patients with MM hospitalized due to GIB. The primary endpoint was inpatient mortality, with secondary endpoints including length of stay and total hospital charges. We utilized multivariable logistic regression analysis to estimate clinical outcomes, considering a significance threshold of P &lt; 0.05. Results: We identified 4,067,364 hospitalizations with GIB, among which 22,000 (5.9%) presented with MM. Comparing MM and Non-MM cohorts, the mean age was 71.9 vs 67.8 years, males constituted 58% vs 52.2%, and White ethnicity accounted for 55.6% vs 66.1%. The prevalence of obesity was 10.6% vs 14.5%, diabetes mellitus was 32.1% vs 33.8%, chronic obstructive pulmonary disease was 16.9% vs 20.4%, dyslipidemia was 38.5% vs 40.7%, atrial fibrillation was 27.7% vs 25.6%, hypertension was 22.9% vs 34.7%, heart failure (HF) was 30.7% vs 26.4%, peripheral vascular disease (PVD) was 2.9% vs 4.1%, acute kidney injury was 45.6% vs 29.4%, anemia was 26.3% vs 27.7% and chronic kidney disease (CKD) was 51.9% vs 28.6%. Clinical outcomes revealed stark differences between MM and Non-MM cohorts: in-hospital mortality rates were 10.9% vs 6.3% with an odds ratio (OR) of 1.5 (CI 1.4-1.7); LOS was 9.6 days vs 6.7 days (IRR 1.26, CI 1.21-1.32); and hospital charges were $30,006 vs $20,172 (IRR 1.34, CI 1.26-1.42). All data demonstrated a p-value &lt; 0.001 and were adjusted for various factors including age, sex, race, comorbidity indices, obesity, atrial fibrillation, diabetes mellitus, hypertension, peripheral vascular disease, acute kidney injury, chronic kidney disease, nicotine and alcohol use, stroke, acute respiratory failure, and inflation during 2017-2020. Conclusions: Patients hospitalized for GIB and MM were comparatively older, with a larger male population and fewer Caucasians. They exhibited higher Afib, HF, AKI, and CKD rates with lower occurrences of obesity, DM, COPD, dyslipidemia, HTN, anemia and PVD. This group showed a significantly worse mortality rate with prolonged hospital stays and resource utilization. This entails to have prompt medical attention, appropriate management of bleeding, and addressing the underlying causes are crucial in improving outcomes and reducing mortality rates. Treatment strategies often involve a multidisciplinary approach involving oncologists, hematologists, gastroenterologists, and other specialists to provide comprehensive care tailored to the individual's condition.

Trends in Initial Anticoagulation Among US Patients Hospitalized With Acute Pulmonary Embolism 2011-2020

Guidelines recommend low-molecular-weight heparin (LMWH) and direct oral anticoagulants (DOACs) rather than unfractionated heparin (UFH) for treatment of acute pulmonary embolism (PE) given their efficacy and reduced risk of bleeding. Using data from a large consortium of US hospitals, we examined trends in initial anticoagulation among hospitalized patients diagnosed with acute PE. We conducted a retrospective study of inpatient and observation cases between January 1, 2011, and December 31, 2020, among individuals aged more than or equal to 18 years treated at acute care hospitals contributing data to the Premier Healthcare Database. Included cases received a diagnosis of acute PE, underwent imaging for PE, and received anticoagulation at the time of admission. The primary outcome was the initial anticoagulant selected for treatment. Among 299,016 cases at 1,045 hospitals, similar proportions received initial treatment with UFH (47.4%) and LMWH (47.9%). Between 2011 and 2020, the proportion of patients initially treated with UFH increased from 41.9% to 56.3%. Over this period, use of LMWH as the initial anticoagulant was reduced from 58.1% in 2011 to 37.3% in 2020. The proportion of cases admitted to the ICU, treated with mechanical ventilation or vasopressors, and inpatient mortality were stable. Factors most strongly associated with receipt of UFH were admission to the ICU (odds ratio [OR] 6.90; 95% confidence interval [CI] 6.31 to 7.54) or step-down unit (OR 2.30; 95% CI 2.16 to 2.45), receipt of thrombolysis (OR 4.25; 95% CI 3.09 to 5.84) or vasopressors (OR 1.83; 95% CI 1.32 to 2.54), and chronic renal disease (OR 1.67; 95% CI 1.54 to 1.81). Despite recommendations that LMWH and DOACs be considered first-line for most patients with acute PE, use of UFH is common and increasing. Further research is needed to elucidate factors associated with persistent use of UFH and opportunities for deimplementation of low-value care.

Impact of pneumocystis pneumonia on clinical outcomes in patients with lung malignancy compared to other malignancies.

e20001 Background: Pneumocystis pneumonia (PCP) is an opportunistic infection that causes significant morbidity and mortality in cancer patients. Although infrequent in solid malignancies, limited studies suggest that PCP portends a worse outcome in patients with lung cancer. We examined hospitalization outcomes for PCP among patients with lung cancer relative to other malignancies. Methods: A retrospective cohort analysis using the Nationwide Inpatient Sample (NIS) database (2010-2019) was conducted. Using ICD-9 and ICD-10 codes, cancer patients admitted for PCP were identified and stratified based on their diagnosis of lung cancer versus other cancer types. Primary outcomes were inpatient mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes included odds of mechanical ventilation, ICU care, bronchoscopy, and palliative care. Statistical analyses were performed using t-tests, univariate and multivariate logistic regression. Results: Among 5,408 hospitalizations for PCP in cancer patients, 10.6% had a diagnosis of lung cancer and 89.4% had other cancer types. Lung cancer patients were older (mean age: 66 vs 62 years; p = 0.001) and had a higher Charlson comorbidity burden (&gt;2) compared to those with other cancers (69.8 vs 34.2%; p&lt;0.001). 31% of lung cancer patients admitted for PCP died compared to 16% of patients with other cancer types ( p&lt;0.001). Multivariate regression analysis showed that hospitalized PCP patients with lung cancer had two-fold higher odds of hospital-associated mortality relative to those with other cancer types (adjusted odds ratio (aOR): 2.2; 95% confidence interval (CI): 1.39-3.37; p = 0.001). Both cohorts had similar LOS (aOR: 0.86; P=0.61; 95% CI: 0.5-1.5) and THC (β -15,377; p=0.113; 95% CI= -34,407-3,653). Among secondary outcomes, lung cancer patients admitted for PCP had higher odds of mechanical ventilation (25.3 vs 17.7%; aOR: 1.61; p = 0.046) and palliative care utilization (24 vs 13%; p=0.002). Conclusions: Pneumocystis pneumonia is associated with significantly higher inpatient mortality among patients with lung cancer compared to other cancers. These patients also had higher rates of mechanical ventilation and palliative care utilization. Health care providers need to maintain a high index of suspicion to facilitate early diagnosis and intervention in order to mitigate adverse outcomes.[Table: see text]

Racial disparities in acute myocardial infarction outcomes in patients with cancer: A nationwide analysis.

e24031 Background: Cancer patients and survivors face an elevated risk of coronary artery disease due to shared risk factors. Risk is further heightened by cancer itself as well as its treatment. Acute myocardial infarction (AMI) is becoming a leading cause of death among this demographic, owing to significant advancements in cancer survival in recent decades. While racial disparities in outcomes and resource utilization in AMI hospitalizations are well-documented, data on patients with cancer remain limited. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions with a principal diagnosis of AMI and a cancer diagnosis using ICD-10 codes. Patients were stratified by their race as – White, Black, Hispanic, Asian and others. Multivariate logistic regression was performed to assess outcomes while adjusting for hospital characteristics, patient demographics and comorbidities between the groups. The primary outcome was inpatient mortality. Results: Out of 3,190,929 admissions for AMI, 93,279 (2.9%) had co-morbid cancer. Among this subset, the majority were White patients (70.9%), followed by Black (11.0%), Hispanic (8.5%), Asian (2.7%), and others (6.9%). Asian patients, compared to White patients, had higher in-hospital mortality (adjusted odds ratio [aOR] 1.52, 95% CI 1.12-2.07, p &lt; 0.01). There was no difference in mortality among other racial groups. There were no differences in complications such as respiratory failure, acute kidney injury, stroke, and vascular complications between the cohorts, although Black patients had lower odds of cardiogenic shock (aOR 0.78, 95% CI 0.62-0.98, p = 0.03) compared to White patients. Compared to White patients, there were lower odds of undergoing coronary angiogram in Black (aOR 0.75, 95% CI 0.68-0.83, p &lt; 0.01), Hispanic (aOR 0.87, 95% CI 0.76-0.99, p = 0.43), and Asian patients (aOR 0.64, 95% CI 0.53-0.79, p &lt; 0.01). Similarly, there were lower odds of undergoing percutaneous coronary intervention (PCI) in Black (aOR 0.64, 95% CI 0.57-0.72, p &lt; 0.01), Hispanic (aOR 0.79, 95% CI 0.68-0.91, p &lt; 0.01), and Asian patients (aOR 0.71, 95% CI 0.56-0.88, p &gt; 0.01). Likewise, there were lower odds of undergoing coronary artery bypass grafting (CABG) in Black (aOR 0.58, 95% CI 0.45-0.76, p &lt; 0.01) and Hispanic patients (aOR 0.70, 95% CI 0.50-0.98, p &lt; 0.04). Conclusions: Cancer patients presenting with AMI experience similar mortality and complications across all races, although in-hospital mortality for Asian was higher compared to White patients. However, significant racial disparities exist in interventions being performed in this patient population. Coronary angiogram, PCI and CABG was performed more often in White patients than other races. Additional research is required to identify the factors contributing to this racial disparity and provide guidance for interventions aimed at improving outcomes.

Trends in the thrombotic complications of myeloproliferative neoplasms: A nationwide analysis.

6581 Background: Thrombotic complications are a well known cause of morbidity and mortality in Philadelphia-negative Myeloproliferative Neoplasms[Polycythemia Vera, Essential thrombocythemia, Primary Myelofibrosis]. Current study evaluated thrombotic events incidence and outcome trends in Myeloproliferative Neoplasms[MPN] from 2012 to 2020. Methods: This is a longitudinal study of thrombotic events in MPN using the Nationwide Inpatient Sample. All patients with a diagnosis of MPN admitted with any thrombotic event including arterial or venous thrombosis were included in the study. Arterial thrombotic events included Myocardial infarction[MI], Ischemic stroke[IS], Transient Ischemic Attack[TIA] while venous thrombotic events included Deep Vein Thrombosis[DVT], Pulmonary Embolism[PE], Budd-Chiari Syndrome[BCS], Portal Vein Thrombosis[PVT]. Thrombosis related inpatient mortality rate, incidence, length of hospital stay, and total hospital charges were calculated. Results: Mortality rate from any thrombotic event overall[arterial plus venous] increased from 2.3% to 2.6% from 2012 to 2020. There was an increase in mortality rates from 2.8% to 3.8% among arterial thrombosis while there was a decrease in venous thrombosis related mortality from 1.7 to 0.4%. Specifically MI and IS related mortality increased from 3.7% to 4.3% and 3% to 4% respectively over the same period. The incidence of any thrombotic event declined from 2 to 1.3 cases/100,000 persons from 2012 to 2020. A similar decline in incidence of arterial, venous events, MI, IS were observed. The mean length of stay decreased from 5.8 days in 2012 to 5.2 days in 2020 among MPN patients with venous thrombosis which was statistically significant. Similar decline was noted in MI patients as well. Though the mean length of stay increased from 7.9 to 9.5 days among MPN patients with IS, this increase was not statistically significant. The mean hospitalization charges for thrombotic events increased from $53,421 in 2012 to $101,598 in 2020 after adjusting for inflation. Similar trends were noted in all types of thrombotic admissions which were all statistically significant. Upon age based stratification of MPN, mortality for those less than 60 years reduced from 2% to 0.3%, while it increased from 4.1 to 5.6% in those more than 60 years from 2012 to 2020. Conclusions: Inpatient mortality from thrombotic events in MPN has shown an increasing trend from 2012 to 2020 though there was a decline in overall incidence of thrombosis during the same period. Despite the decreasing trend in length of stay, the total economic burden of thrombotic complications in MPN is increasing in the US. Specifically the effects were more pronounced in those greater than 60 years. This points to the need for revisiting guidelines regarding thromboprophylaxis in MPN.

Racial disparities in patients with ALL according to a national dataset.

e13733 Background: Racial disparities in healthcare refer to differences in health outcomes, access to healthcare &amp;quality of care among racial or ethnic groups. Aim of study is to investigate the characteristics and clinical outcomes of racial differences in patients admitted with ALL. Methods: We queried the National Inpatient Sample between 2017-2020 for adult patients of different races who were hospitalized with ALL. The primary outcome was inpatient mortality; secondary outcomes were cardiac arrest, invasive mechanical ventilation, length of stay &amp; hospital cost. Multivariable logistic, linear &amp; Poisson regression analyses were used to estimate clinical outcomes with p-value &lt; 0.05 was significant. Results: Total 110999 hospitalizations with ALL. Mean age 46 years &amp; 55.8% male. Among admitted, 59599 (53.7 %) were Caucasian, 9205 (8.3 %) were Black, 27565 (24.8%) were Asian, 4540 (4.1%) were Hispanic, and 10090 (9.1%) were others. Subgroup with Caucasian, Blacks, Asians, Hispanics, and other races had Medicare 34.9% vs 30.2% vs 13.5% vs 17.9% vs 12.5%, Medicaid 13.3% vs 29.7% vs 41.4% vs 19.2 vs 34.8%, Non-insured 2.1% vs 5.1% vs 10.6% vs 4.2% vs 7.7%; DM 19% vs 23.8% vs 24.6% vs 17.4% vs 20.7%; Protein calorie malnutrition 11 % vs 10.6% vs 10.1% vs 12.6% vs 10.2%, respectively. All-cause mortality was 3810, where subgroup with Caucasian, Black, Asian, Hispanic, and others were 2085 (3.5%) vs 410 (4.4%) vs 885 (3.2%) vs 145 (3.2%) vs 285 (2.8%). Conclusions: Among the racial categories, Caucasians comprised the largest portion followed by Asians, Blacks, Hispanics. Mortality and intubation proportion was highest among Blacks followed by Hispanics &amp; Asians. Cardiac arrest proportion was highest among Blacks followed by Hispanics and Asians. LOS was highest among Hispanics followed by Asians &amp; Blacks. Resource utilization was highest in Hispanics followed by Asians &amp; Blacks. Understanding these disparities is essential for improving healthcare equity and ensuring that all patients receive appropriate &amp; equitable care regardless of their racial/ethnic background. Interventions include improving access to healthcare, culturally competent care and addressing social determinants of health that affect racial/ethnic groups. [Table: see text]

In-hospital outcomes of patients with myelodysplastic syndromes and rheumatic heart disease: A National Inpatient Sample study (2018-2020).

e18525 Background: Autoimmune conditions are relatively uncommon in patients with Myelodysplastic syndromes (MDS), with only a small proportion of patients affected. Among these autoimmune conditions, rheumatic heart disease (RHD) is the most commonly associated with MDS. Very few cases have been reported in literature that show the impact of RHD on patients diagnosed with MDS. In this study, we aimed to investigate the impact of RHD on the patients with myelodysplastic syndrome who were admitted in hospitals from 2018-2020. Methods: We utilized National Inpatient Sample (NIS) 2018-2020 to identify hospitalizations of patients with Myelodysplastic syndromes with a secondary diagnosis of Rheumatic heart disease. The primary outcomes examined were In-patient mortality and average length of stay, All the patients with MDS were divided into two cohorts based on the presence of rheumatic heart disease. Multivariable regression analyses were conducted, taking into account demographics, hospital-level characteristics, and pertinent comorbidities as adjusting factors. Results: Using the NIS dataset from 2018 to 2020, we identified 222,364 patients admitted with MDS during this period. Among them, 4.57% (10,162 patients) also had a diagnosis of rheumatic heart disease (RHD). The average age of patients with MDS and RHD was 80 years. Among these patients, 50.1% were male and 49.9% were female. The mortality rate among patients admitted with MDS and coexisting RHD was 7.7%. Multivariate regression analysis indicated that the presence of RHD increased the likelihood of mortality with an odds ratio (OR) of 1.2 (95% confidence interval [CI]: 1.0-1.4, p-value &lt;0.05). Additionally, RHD was associated with a higher incidence of arrhythmias (OR: 2.9) and congestive heart failure (OR: 5.0) among MDS patients. The total hospital charges were more in patients with RHD than those without RHD ($80108 vs $82843). However, there was no significant difference in the length of stay (LOS) between patients with MDS alone and those with MDS and RHD. Conclusions: Rheumatic heart disease (RHD) cases in patients with MDS are rare in clinical practice, leading to uncertainty regarding the effects of RHD on admitted MDS patients. Our study sheds light on the influence of RHD on mortality and other outcomes in this patient population. The efficacy of timely RHD treatment in reducing mortality and improving outcomes among hospitalized MDS patients remains to be verified in future investigations. [Table: see text]

Differences in the Impact of Obesity and Bariatric Surgery on Patients Hospitalized for Atrial Flutter and Atrial Fibrillation: A Nationwide Analysis, 2016-2020.

The "obesity paradox" claims that although obesity is a risk factor for atrial fibrillation, obese patients have lower inpatient mortality when admitted due to atrial fibrillation. This study aims to analyze if the obesity paradox still holds true after weight loss from bariatric surgery. Methods: This study analyzed discharge data from the National Inpatient Sample, 2016-2020. Patients admitted due to atrial fibrillation or atrial flutter, with or without obesity, and with or without a past medical history of bariatric surgery were identified using ICD-10-CM and ICD-10-PCS codes. The primary outcome was mortality. Secondary outcomes included length of stay, resource utilization, necessity for endotracheal intubation, and necessity for cardioversion. STATA v.13 was used for univariate and multivariate analysis (StataCorp LLC, Texas, USA). Among 2,292,194 patients who had a primary diagnosis of atrial fibrillation or atrial flutter, 494,830 were obese and 25,940 had bariatric surgery. Mortality was not significantly different in post-bariatric surgery patients when compared to the general population (OR 0.76; 95% [CI 0.482-1.2; p=0.24]). Mortality was significantly lower in obese patients when compared to the general population (OR 0.646; 95% [CI 0.583-0.717; p<0.001]). Therefore, post-bariatric surgery patients had a higher mortality than obese patients when compared to the general population. Obese patients spent more days in the hospital (regression 0.219; 95% [CI 0.19-0.248, p<0.001]), had higher resource utilization (regression 3491.995; 95% [CI 2870.085-4113.905, p<0.001]), more cardioversions (OR 1.434; 95% [CI 1.404-1.465; p<0.001]), and no difference in endotracheal intubation rate (OR 1.02; 95% [CI 0.92-1.127; p=0.724]) when compared to the general population. Post-bariatric patients had no difference in length of stay (regression -0.053; 95% [CI -0.137-0.031; p=0.218]) and resource utilization (regression 577.297; 95% [CI -1069.801-2224.396; p=0.492]), fewer endotracheal intubations (OR 0.583; 95% [CI 0.343-0.99; p=0.046]), and more cardioversions (OR 1.223; 95% [CI 1.134-1.32; p<0.001]) when compared to the general population. Compared to the general population, post-bariatric patients had higher inpatient mortality than obese patients when admitted due to atrial fibrillation or atrial flutter. This research reinforces the presence of the obesity paradox following bariatric surgery with respect to mortality.

Impact of delirium on in-patient outcomes in patients with pancreatic cancer: A nationwide study.

e16369 Background: Pancreatic cancer is the fourth leading cause of cancer-related death in the United States. Anecdotal evidence suggests that delirium, characterized by a state of disorientation and confusion, is associated with adverse clinical outcomes, especially in aggressive diseases like cancer. We aim to analyze the impact of delirium on outcomes in patients hospitalized with pancreatic cancer. Methods: The National Inpatient Sample (2017-2020) was employed to identify patients who were admitted with a primary diagnosis of pancreatic cancer. Multivariate regression analysis was employed and the results of this study were reported adhering to the STROBE guidelines. Our primary outcome was inpatient mortality in patients with pancreatic cancer with and without a concurrent diagnosis of delirium. The secondary outcomes included the length of hospital stay, the total cost of hospitalization, and clinical complications or outcomes such as Fluid and Electrolyte Disorders, AKI, Major Depressive Disorder, etc. Baseline characteristics were comparable between patients in either group. Results: A total of 149525 patients had a diagnosis of pancreatic cancer, among which 1850 had concurrent delirium. The mean age of patients with and without delirium was 72.92±SD vs 68.24±SD years, respectively ( p = 0.004). Patients with delirium were found to have higher odds of in-patient mortality (OR = 3.89, 95% CI: 2.78- 5.44 , p &lt; 0.001). Length of stay and total hospitalization cost were also significantly increased in patients with concurrent delirium (+6.69 days, 95% CI 5.32-8.05, P &lt; 0.001 and + USD 104355, 95% CI 71358- 137352 , p &lt; 0.001, respectively). Similarly, pancreatic cancer patients with delirium had increased likelihood of fluid and electrolyte imbalance (OR = 1.51 95% CI 1.19-1.90, p &lt; 0.001), acute kidney injury (OR = 2.31, 95% CI 1.76-3.04, p &lt; 0.001), major depressive disorder (OR = 1.46, 95% CI 1.06-2.01, p = 0.02), anxiety (OR = 2.19, 95% CI 1.67-2.88, p &lt; 0.001), dementia (OR = 5.58, 95% CI 4.10-7.59, p &lt; 0.001), pneumonia (OR = 1.99, 95% CI 1.19-3.33, p = 0.008), sepsis (OR = 3.13, 95% CI 2.13-4.61, p &lt; 0.001), acute respiratory failure (OR = 3.05, 95% CI 2.16-4.31, p &lt; 0.001), ICU admission (OR = 3.31, 95% CI 2.34-4.68, p &lt; 0.001), mechanical ventilation (OR = 3.79, 95% CI 2.57-5.59, p &lt; 0.001), vasopressor use (OR = 2.62, 95% CI 1.34-5.11, p = 0.004), cardiac arrest (OR = 2.50, 95% CI 1.05-6.24 , p = 0.04). Conclusions: Delirium in hospitalized patients with pancreatic cancer results in worse clinical outcomes and is an independent predictor of mortality. It is associated with a four-fold increase in mortality and a significant increase in length of stay, total cost of hospitalization and worse clinical outcomes. Appropriate management of delirium in patients with pancreatic carcinoma is therefore crucial for decreasing morbidity and mortality among these patients.

Influence of gender on acute kidney injury among patients undergoing chimeric antigen receptor T-cell (CAR-T cell) therapy: Insights from National Inpatient Sample.

e14524 Background: Chimeric antigen receptor T-cell (CAR-T Cell) immunotherapy has shown promising results in patients with B-cell leukemia and lymphoma and multiple myeloma. The side effect profile is still being studied and acute kidney injury (AKI) following treatment has been a commonly reported outcome in the context of cytokine release syndrome. In most cases, the kidney injury is reversible with adequate hydration and treatment of the underlying cytokine release syndrome when needed. This study aimed to investigate the outcomes of gender in patients undergoing CAR-T cell therapy along with the protective variables and independent predictors of AKI in this patient population. Methods: This was a retrospective analysis of data the National Inpatient Sample (NIS) between January 2019 and December 2020 to identify patients who underwent CAR-T cell therapy. We stratified the data based on gender and studied the incidence of AKI in patient admitted to the hospital primarily for CAR-T cell treatment. The primary endpoint was in-hospital mortality, AKI, average age, length of stay (LOS), and total charge by hospital. Additionally, we explored independent predictors and protective variables for AKI in patients receiving the treatment. Results: A total of 4010 patients underwent CAR-T Cell therapy from January 2019 to December 2020. Among these patients, females comprised 41.1% (n=1650). The mean age at the time of CAR-T cell treatment for males was 57.5 and for females 56.9. The inpatient mortality rates for both groups were 3% (p=0.97). The total incidence of AKI in patients undergoing CAR-T cell therapy was 14.9%, with rates of 19% in males and 9% in females (p&lt;0.01). LOS for males and females was 19 days, and 20 days respectively (p=0.4). Average total hospital charge for males was 958,345 and 1,017,685 for females (p=0.3642). Interestingly, there was no difference between genders in relation to the incidence of cytokine release syndrome (p=0.3). Notably, CKD, obesity, liver disease, and electrolyte imbalances were independent predictors of AKI with an adjusted odds ratio of 4.26 (p&lt;0.01; 95% confidence interval [CI]: 1.7-10.6), 2.7 (p=0.015; 95% CI: 1.2-6.06), 2.7 (p=0.045; 95% CI: 1.02-7.23), 2.5 (p&lt;0.01; 95% CI: 1.67-3.81). Importantly, gender was a protective variable for females when it came to AKI after CAR-T cell therapy with an adjusted odds ratio of 0.38 (p&lt;0.01; 95% CI: 0.23-0.63). Conclusions: AKI has been documented as a common side effect in patients undergoing CAR-T cell therapy. In most cases the kidney injury is reversible with adequate hydration and CRS treatment when necessary. Our study highlights CKD, obesity, liver disease, and electrolyte imbalance as independent predictors of AKI after CAR-T cell therapy and female gender as a predictive variable against developing AKI.

Gender disparity in chimeric antigen receptor T-cell therapy utilization and outcomes in the United States.

2556 Background: Chimeric antigen receptor T-cell [CART] therapy has marked a new era in the treatment of relapsed/refractory hematological malignancies since its approval in 2017. Racial disparity was studies previously but not gender. Current study aimed to evaluate gender disparity in CART therapy utilization and outcomes. Methods: This cross sectional study was done using National Inpatient Sample [NIS], the largest database available in the US. Inpatient admissions of adults who received CART therapy for various indications during year 2020 were included. Results: A total of 6915 patients were admitted to hospital for CART therapy in 2020 with an overall inpatient mortality rate of 1%. Mean age of the patients was 57yr. Majority were White [64%], with a higher median household income, admitted to urban and large sized hospitals and predominantly covered by Medicare or private insurance [~80%]. Study population was divided into males and females and outcomes were compared. Females were significantly younger with lower Charlson comorbidity index and higher utilization of CART therapy [81% vs 19%] compared to males. Females had 86% lesser odds of mortality compared to males (Odds Ratio [OR] 0.14; 95% confidence interval [CI] 0.04-0.47; p value 0.001). Females had significantly lesser hospitalization charges [mean decrease $471,193; p value 0.000] and length of stay [mean decrease 8 days; p value 0.000] compared to males after adjusting for confounders. Racial differences in outcome were compared after multiple imputation was used to correct for 4% missing data in the race category in NIS 2020. There was no statistically significant difference in mortality, length of stay or hospitalization charges between Whites, Blacks and Hispanic races similar to previous studies. Conclusions: Eligibility criteria for CART therapy includes patients with good performance status and organ function with less comorbidities. Our study found that females were younger, healthier and therefore qualified better for CART therapy compared to males. Hence they had significantly higher utilization of CART therapy. In addition, among the population receiving CART therapy, females had better outcomes compared to males in terms of mortality, length of stay and hospitalization charges. In general, males have higher incidence and mortality with poorer outcomes in most hematological malignancies where CART therapy is a treatment option. Measures at modifying and improvising CART therapy to cater to more male subjects will not only reduce gender disparity but also improve overall survival and reduce disease burden. [Table: see text]

Association of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) With an Increased Risk of Congestive Heart Failure in Hospitalized Patients With Cirrhosis: A Propensity Score-Matched Analysis.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to increased cardiovascular (CV) risks, notably congestive heart failure (CHF). We evaluated the influence of MASLD on CHF and mortality among hospitalized cirrhotic patients. We analyzed the National Inpatient Sample from 2016 to 2020, identifying adult cirrhosis patients. We focused on CHF and in-hospital mortality, plus hospital stay length, costs, and discharge status. Propensity score matching created balanced cohorts for comparison. Poisson and logistic regression provided adjusted CHF risks and mortality odds ratios (ORs) for MASLD patients. Before matching, 4.1% of 672,625 cirrhotic patients had MASLD. Post-matching, each group had 23,161 patients. Patients with MASLD showed higher CHF risk (OR 1.14, 95% CI 1.10-1.21, p<0.001) but lower in-hospital mortality (OR 0.57, 95% CI 0.52-0.63, p<0.01) and decreased costs (median $24,447 vs. $28,630, OR 0.86, 95% CI 0.85-0.87, p<0.001). In this nationwide study of patients with cirrhosis, MASLD was associated with a higher prevalence of CHF and lower in-patient mortality. These findings mirror the "adiposity paradox" phenomenon, where obese/overweight individuals with cardiometabolic dysfunction may experience less severe or beneficial health outcomes than those with a normal weight. Further investigation is warranted to decode the intricate interplay between MASLD, cirrhosis, CHF, and in-hospital mortality and its clinical practice implications.