Presentation Details
| Temporal Trends and Predictors of Venous Thromboembolism in Hospitalized Chronic Lymphocytic Leukemia Patients Michael Imeh1, Ani Gvajaia1, Chukwunonye Amaeshi2, Fidelis Uwumiro3. 1Lincoln Medical and Mental Health Centre, Bronx, NY, USA.2Montefiore Medical Centre, Bronx, NY, USA.3University of Benin Teaching Hospital, Benin, Nigeria |
Abstract
Background/Objectives: Venous thromboembolism (VTE) is associated with inferior survival in patients with chronic lymphocytic leukemia (CLL). This study assessed the prevalence, trends, and predictors of VTE in hospitalized patients with CLL. Methods: We analyzed adult hospitalizations for CLL with or without VTE from the 2017–2020 nationwide inpatient sample database using the International Classification of Diseases, 10th revision codes. Baseline characteristics were compared using χ2 tests and Student’s t-test for categorical and continuous variables. Trends in CLL hospitalization, VTE incidence, mortality, and hospital costs were assessed using the Jonckheere-Terpstra test. The predictors of VTE were assessed using stepwise multivariable logistic regression. Illness severity, risk of mortality, and comorbidity burden were adjusted using all patient refined-diagnosis-related groups (APR-DRG) metrics and the Charlson comorbidity index. Hospital costs were adjusted for inflation using the medical expenditure panel survey index. Results: The study analyzed 17,945 hospitalizations for CLL. Overall, the incidence of VTE was 7.3%. Most patients were male (64.3%) and white (78.9%), with a mean age of 71.8 years (SD, 11.6 years). During the study period, hospitalizations for CLL decreased from 4,670 to 4,245, marking a 9.1% reduction (Ptrend <0.001). However, the incidence of VTE showed an upward trend, increasing from 230 cases (4.9%) to 344 cases (7.4%; Ptrend <0.001). Concurrently, inpatient mortality rates declined, dropping from 400 cases (8.6%) to 214 cases (5.1%; Ptrend <0.001). Additionally, the mean cost of hospitalization for patients with VTE significantly increased from $73,141 to $100,630 during the period (Ptrend <0.001). Predictors of VTE identified in the study included prolonged hospital stay (≥16 days) (aOR: 1.60; 95% CI: 1.06-2.40; P=0.025), sepsis (aOR: 1.76; 95% CI: 1.33-3.12; P=0.004), major loss of function (APR-DRG severity = 2; aOR: 2.30; 95% CI: 1.07-4.98; P=0.034) or extreme loss of function (APR-DRG severity = 3; aOR: 3.99; 95% CI: 1.63-9.74; P=0.002), Medicare insurance (aOR: 1.27; 95% CI: 1.18-1.48; P=0.033), age ≥60 years (aOR: 1.08; 95% CI: 1.01-1.27; P=0.041), obesity (aOR: 1.22; 95% CI: 1.06-2.21; P=0.016), and other primary neoplasia (aOR: 2.62; 95% CI: 1.39-4.21; P=0.006). Conclusion: CLL hospitalization and VTE-associated mortality decreased. However, the incidence rate of VTE and associated resource utilization continue to exhibit an increasing trend. Obese patients aged over 60 years, particularly those with major functional loss, concurrent septicemia, or other primary neoplasia, who were hospitalized for ≥16 days exhibited a higher risk of developing VTE.
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