- Email: [email protected]
Comparison of Outcomes in Hospitalizations for Sepsis in Patients with Hematopoietic Stem Cell Transplantation: A Nationwide Analysis
Abstracts / Biol Blood Marrow Transplant 25 (2019) S290 S442
want to determine if there is a correlative impact on quality of life. Methods: We have enrolled 20 myeloma participants and 20 control participants, made up largely of caregivers. After informed consent, we perform cognitive testing using selected tests from the NIH Toolbox cognitive domain, administered on an iPad. These tests assess processing speed, working memory, attention, and executive function at four time points: at diagnosis, after initial treatment, four months later or 100 days postautologous stem cell transplant, and nine months after that or one year post-autologous transplant. A quality of life questionnaire (FACT-MM) is also completed at the time of each testing. Current Status: We have collected baseline and secondary time-point data thus far with limited tertiary time-point data. We will continue to study this population longitudinally through early 2020 to complete testing. Preliminary data shows that myeloma patients and controls have similar baseline cognition with mean cognitive scores of 47.8 and 47.9, respectively. Controls appear to improve cognitively at the second testing, with a mean score of 52.7, likely due to practice effect. Myeloma patients stay about the same to slightly worse following induction treatment with a mean cognitive score of 45.6. Interestingly, our quality-of-life data suggests that myeloma patients improve functionally and emotionally following initial treatment, but controls (i.e. caregivers) worsen slightly, both functionally and emotionally, which endorses the growing priority of caregiver support.
565 Comparison of Outcomes in Hospitalizations for Sepsis in Patients with Hematopoietic Stem Cell Transplantation: A Nationwide Analysis Karan Jatwani MD1, Karan Chugh MD2, Shraddha Jatwani MD2. 1 Mount Sinai West - St Luke’s Hospital, New York, NY; 2 St. Vincent Evansville, Evansville, IN Background: Sepsis with multiple organ failure is one of the frequent causes of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Patients with HSCT are at particular risk of developing sepsis due to their immunocompromised state. Studies have suggested that anywhere from 3.3% and 55% of such patients require Intensive Care admissions. Reports on outcomes of patients with sepsis with HSCT are limited. With our study we aim to study the demographics and outcomes of sepsis in adult patients with HSCT. Methods: We analyzed hospitalizations for sepsis among adults in the Nationwide Inpatient Sample (NIS) available through Agency for Healthcare Research and Quality as a part of Healthcare Cost and Utilization Project. Patients were stratified into two groups based on the status of HSCT; using ICD-9 CM diagnostic codes. Descriptive statistics were represented as means/medians for continuous and as frequencies and percentages for categorical variables. A survey weighted multivariate regression analysis was used to adjust for confounders when calculating mortality. Results: A total of 4501621 admissions with sepsis were identified from 2010-2014 and amongst these 4396 admissions also had underlying HSCT. Patients with history of HSCT admitted with sepsis was younger in age (55.96 years vs 67.06 years; p value= 0.00), mostly males (60.56% vs 48.23%; p value=0.00) and increased comorbidities. They were more likely to be admitted to an urban teaching hospital. Patients with history of HSCT had increased mortality (17.82% patients vs 14.22% patients; p value=0.002) and increased costs per hospitalization ($ 83241 vs $65590; p value=0.0003). There was no significant difference in length of stay. When adjusted for confounders, patients admitted with sepsis with history of HSCT were found to have a 56%
S375
increased risk of mortality compared to general population. (Odds Ratio=1.565; 95% CI 1.283-1.911; p value=0.00). Conclusion: Patients admitted with sepsis with history of HSCT are more likely to have poor outcome from sepsis than nontransplant patients. Clinicians should be vigilant about the screening and managing infections timely in patients with history of HSCT, to prevent poor outcomes from sepsis in patients with HSCT. Implementationof strategies that are known to improve outcomes in sepsis such as early administration of antibiotics and fluid resuscitation may be of particular importance in this high-risk population.
566 Depression and Infection Rates in Hematopoietic Stem Cell Transplant Patients Rohan Ahluwalia MD1, Phil Yeung Pharm D, MBA, MSP, MAS2, Dimitrios Tzachanis MD, PhD3. 1 Blood and Marrow Transplant Program, University of California San Diego, La Jolla, CA; 2 UCSD Blood and Marrow Transplant Program, University of California San Diego, La Jolla, CA; 3 Blood and Marrow Transplant Program, University of California San Diego, San Diego, CA Introduction and Objectives: Clinical and epidemiological data suggest that depression may increase the risk for infection. Infection is a major cause of morbidity and mortality in patients undergoing stem cell transplantation. We investigated the impact of depression on infection rates in patients undergoing autologous or allogeneic stem cell transplant at a single center. Methods: We analyzed data from University of California San Diego’s Hematopoietic Stem Cell Transplant program to compare outcomes after autologous (n= 472) and allogeneic (n= 259) transplants in patients with hematologic malignancies and with an existing diagnosis of depression versus no depression. Using chi-square testing, we compared the infection rates between patients with or without depression. Results: The study included 162 (22.2%) patients with depression versus 568 (77.9%) without depression who underwent allogeneic and autologous stem cell transplant between 2012 and 2017. Using Pearson Chi-square testing, patients with depression had a higher rate of infections (55.6%) versus patients without depression (41%, p= 0.001). Depression was associated with multiple infection sites (25% vs 17%, p=0.029), increased risk for bacterial infection (44% versus 28.5%, P<0.0001), and increased risk for fungal infection (10% versus 4%, P=0.002). In allogeneic transplant patients, depression led to significantly more acute graft versus host disease (65% versus 45%, p=0.003) and chronic graft versus host disease (41% versus vs 20.4). Conclusion: In our retrospective analysis depression was associated with higher rates of overall infection, bacterial, and fungal infection among hematopoietic transplant patients. Depression was also associated with increased risk for both acute and chronic graft versus host disease. If our observation is confirmed prospectively, then interventions aimed at depression, might improve infection rates in transplant patients. Table 1 Depressed and non-depressed transplant patients with infection
want to determine if there is a correlative impact on quality of life. Methods: We have enrolled 20 myeloma participants and 20 control participants, made up largely of caregivers. After informed consent, we perform cognitive testing using selected tests from the NIH Toolbox cognitive domain, administered on an iPad. These tests assess processing speed, working memory, attention, and executive function at four time points: at diagnosis, after initial treatment, four months later or 100 days postautologous stem cell transplant, and nine months after that or one year post-autologous transplant. A quality of life questionnaire (FACT-MM) is also completed at the time of each testing. Current Status: We have collected baseline and secondary time-point data thus far with limited tertiary time-point data. We will continue to study this population longitudinally through early 2020 to complete testing. Preliminary data shows that myeloma patients and controls have similar baseline cognition with mean cognitive scores of 47.8 and 47.9, respectively. Controls appear to improve cognitively at the second testing, with a mean score of 52.7, likely due to practice effect. Myeloma patients stay about the same to slightly worse following induction treatment with a mean cognitive score of 45.6. Interestingly, our quality-of-life data suggests that myeloma patients improve functionally and emotionally following initial treatment, but controls (i.e. caregivers) worsen slightly, both functionally and emotionally, which endorses the growing priority of caregiver support.
565 Comparison of Outcomes in Hospitalizations for Sepsis in Patients with Hematopoietic Stem Cell Transplantation: A Nationwide Analysis Karan Jatwani MD1, Karan Chugh MD2, Shraddha Jatwani MD2. 1 Mount Sinai West - St Luke’s Hospital, New York, NY; 2 St. Vincent Evansville, Evansville, IN Background: Sepsis with multiple organ failure is one of the frequent causes of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Patients with HSCT are at particular risk of developing sepsis due to their immunocompromised state. Studies have suggested that anywhere from 3.3% and 55% of such patients require Intensive Care admissions. Reports on outcomes of patients with sepsis with HSCT are limited. With our study we aim to study the demographics and outcomes of sepsis in adult patients with HSCT. Methods: We analyzed hospitalizations for sepsis among adults in the Nationwide Inpatient Sample (NIS) available through Agency for Healthcare Research and Quality as a part of Healthcare Cost and Utilization Project. Patients were stratified into two groups based on the status of HSCT; using ICD-9 CM diagnostic codes. Descriptive statistics were represented as means/medians for continuous and as frequencies and percentages for categorical variables. A survey weighted multivariate regression analysis was used to adjust for confounders when calculating mortality. Results: A total of 4501621 admissions with sepsis were identified from 2010-2014 and amongst these 4396 admissions also had underlying HSCT. Patients with history of HSCT admitted with sepsis was younger in age (55.96 years vs 67.06 years; p value= 0.00), mostly males (60.56% vs 48.23%; p value=0.00) and increased comorbidities. They were more likely to be admitted to an urban teaching hospital. Patients with history of HSCT had increased mortality (17.82% patients vs 14.22% patients; p value=0.002) and increased costs per hospitalization ($ 83241 vs $65590; p value=0.0003). There was no significant difference in length of stay. When adjusted for confounders, patients admitted with sepsis with history of HSCT were found to have a 56%
S375
increased risk of mortality compared to general population. (Odds Ratio=1.565; 95% CI 1.283-1.911; p value=0.00). Conclusion: Patients admitted with sepsis with history of HSCT are more likely to have poor outcome from sepsis than nontransplant patients. Clinicians should be vigilant about the screening and managing infections timely in patients with history of HSCT, to prevent poor outcomes from sepsis in patients with HSCT. Implementationof strategies that are known to improve outcomes in sepsis such as early administration of antibiotics and fluid resuscitation may be of particular importance in this high-risk population.
566 Depression and Infection Rates in Hematopoietic Stem Cell Transplant Patients Rohan Ahluwalia MD1, Phil Yeung Pharm D, MBA, MSP, MAS2, Dimitrios Tzachanis MD, PhD3. 1 Blood and Marrow Transplant Program, University of California San Diego, La Jolla, CA; 2 UCSD Blood and Marrow Transplant Program, University of California San Diego, La Jolla, CA; 3 Blood and Marrow Transplant Program, University of California San Diego, San Diego, CA Introduction and Objectives: Clinical and epidemiological data suggest that depression may increase the risk for infection. Infection is a major cause of morbidity and mortality in patients undergoing stem cell transplantation. We investigated the impact of depression on infection rates in patients undergoing autologous or allogeneic stem cell transplant at a single center. Methods: We analyzed data from University of California San Diego’s Hematopoietic Stem Cell Transplant program to compare outcomes after autologous (n= 472) and allogeneic (n= 259) transplants in patients with hematologic malignancies and with an existing diagnosis of depression versus no depression. Using chi-square testing, we compared the infection rates between patients with or without depression. Results: The study included 162 (22.2%) patients with depression versus 568 (77.9%) without depression who underwent allogeneic and autologous stem cell transplant between 2012 and 2017. Using Pearson Chi-square testing, patients with depression had a higher rate of infections (55.6%) versus patients without depression (41%, p= 0.001). Depression was associated with multiple infection sites (25% vs 17%, p=0.029), increased risk for bacterial infection (44% versus 28.5%, P<0.0001), and increased risk for fungal infection (10% versus 4%, P=0.002). In allogeneic transplant patients, depression led to significantly more acute graft versus host disease (65% versus 45%, p=0.003) and chronic graft versus host disease (41% versus vs 20.4). Conclusion: In our retrospective analysis depression was associated with higher rates of overall infection, bacterial, and fungal infection among hematopoietic transplant patients. Depression was also associated with increased risk for both acute and chronic graft versus host disease. If our observation is confirmed prospectively, then interventions aimed at depression, might improve infection rates in transplant patients. Table 1 Depressed and non-depressed transplant patients with infection