Early mortality and complications in hospitalized adult Californians with acute myeloid leukaemia

SUMMARY

Few studies have evaluated the impact of complications, sociodemographic and clinical factors on early mortality (death ≤ 60 days from diagnosis) in acute myeloid leukaemia (AML) patients. Using data from the California Cancer Registry linked to hospital discharge records from 1999–2012, we identified patients aged ≥ 15 years with AML who received inpatient treatment (N=6359). Multivariate logistic regression analyses were used to assess the association of complications with early mortality, adjusting for sociodemographic factors, comorbidities and hospital type.

Early mortality decreased over time (25.3%, 1999–2000; 16.8%, 2011–2012) across all age groups, but was higher in older patients (6.9%, 15–39, 11.4%, 40–54, 18.6% 55–65, and 35.8%, > 65 years). Major bleeding (Odds ratio [OR] 1.5, 95% confidence interval [CI] 1.3–1.9), liver failure (OR 1.9, 95% CI 1.1–3.1), renal failure (OR 2.4, 95% CI 2.0–2.9), respiratory failure (OR 7.6, 95% CI 6.2–9.3) and cardiac arrest (OR 15.8, 95% CI 8.7–28.6) were associated with early mortality. Higher early mortality was also associated with single marital status, low neighbourhood socioeconomic status, lack of health insurance and comorbidities. Treatment at National Cancer Institute-designated cancer centres was associated with lower early mortality (OR 0.5, 95% CI 0.4–0.6).

In conclusion, organ dysfunction, hospital type and sociodemographic factors impact early mortality. Further studies should investigate how differences in healthcare delivery affect early mortality.