Predictors of disseminated intravascular coagulation in patients with acute myeloid leukemia with severe sepsis and septic shock.

person Saisree Reddy Adla Jala Centinela Hospital Medical Center, Inglewood, CA info_outline Saisree Reddy Adla Jala, Dhruvkumar Gadhiya, Yogeshwaree Ramphul, Madho Mal, Nayanika Tummala, Kanwar Bir Singh Dhaliwal, Hemamalini Sakthivel, Mehndi Dandwani, Kamleshun Ramphul, Suma Sri Chennapragada

Authors person Saisree Reddy Adla Jala Centinela Hospital Medical Center, Inglewood, CA info_outline Saisree Reddy Adla Jala, Dhruvkumar Gadhiya, Yogeshwaree Ramphul, Madho Mal, Nayanika Tummala, Kanwar Bir Singh Dhaliwal, Hemamalini Sakthivel, Mehndi Dandwani, Kamleshun Ramphul, Suma Sri Chennapragada Organizations Centinela Hospital Medical Center, Inglewood, CA, St. Luke's University Health Network Anderson Campus, Easton, PA, SSRN Hospital, Pamplemousses, Mauritius, Liaquat University of Medical and Health Science Jamshoro, Jamshoro, Pakistan, GITAM Institute Of Medical Sciences And Research, Visakhapatnam, India, Government Medical College Patiala, Patiala, India, One Brooklyn Health System/Interfaith Medical Center, New York, NY, University of Iowa Hospitals and Clinics, Iowa, IA, Independent Researcher, Triolet, Mauritius, LSU Health Shreveport, Shreveport, LA Abstract Disclosures Research Funding No funding sources reported Background: Multiple pathophysiological pathways predispose Acute Myeloid Leukemia (AML) patients to Disseminated Intravascular Coagulation (DIC). As sepsis can also trigger DIC, we aim to evaluate the predictors of DIC among AML patients with severe sepsis and septic shock. Methods: We queried adults with a diagnosis of AML and severe sepsis with septic shock admitted between 2016 and 2020 in the United States via the National Inpatient Sample(NIS). Patients ages <18 years were excluded from our sample. Multivariate regression models were used to estimate the impact of multiple factors on events of DIC among these patients. Results: Our sample consisted of 19545 cases of severe sepsis with septic shock in AML adults that matched our selection criteria. It included 1705(8.7%) patients who also experienced DIC during hospitalization. Several factors, such as medium (aOR 2.174, p<0.01) and high frailty risk (aOR 1.788, p<0.01, vs. Low frailty risk), history of nutritional anemia (aOR 1.580, p<0.01), cirrhosis (aOR 2.316, p<0.01), chronic kidney disease (CKD) (aOR 1.319, p<0.01), systemic lupus erythematosus (SLE) (aOR 1.845, p=0.040), Females (vs. Males, aOR 1.169, p<0.01), and patients covered by Medicaid (vs. Medicare, aOR 1.325, p<0.01) showed higher odds of DIC. In addition, those ages ≥60 years were less likely to experience an event of DIC (aOR 0.699, p<0.01), as DIC patients were younger (mean age 58.85 years vs. 62.43 years, p<0.01). Patients with obesity (aOR 0.605, p<0.01), smoking (aOR 0.772, p<0.01), and cachexia (aOR 0.738, p=0.038) also showed fewer events of DIC. However, no racial differences were found between Blacks(aOR 0.928, p=0.404) or Hispanics (aOR 1.019, p=0.831)(vs. Whites). DIC patients who died were also older (mean age 59.99 years vs. 56.19 years, p<0.01). Finally, we were also able to confirm that events of DIC led to poorer prognosis with a higher rate of all-cause mortality (70.1% vs. 47.6%, aOR 2.169, p<0.01). Conclusions: Factors increasing the risk of DIC in patients with AML and severe sepsis with septic shock included anemia, cirrhosis, CKD, SLE, medium and high frailty risk, female sex, and Medicare insurance. While we noted lower odds of DIC among patients who are ≥60 years old, obese, cachectic, and smokers, further hospital-based studies to evaluate the severity of their illnesses along with other variables that could be analyzed via the NIS should be encouraged.