Premium
Early mortality and complications in hospitalized adult Californians with acute myeloid leukaemia
Author(s) -
Ho Gwendolyn,
Jonas Brian A.,
Li Qian,
Brunson Ann,
Wun Ted,
Keegan Theresa H. M.
Publication year - 2017
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.14631
Subject(s) - medicine , odds ratio , confidence interval , marital status , medical record , pediatrics , population , environmental health
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 to 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.