Impact of Sepsis in Acute Myeloid Leukemia Outcomes: A National Inpatient Sample Analysis from 2016 to 2020

Introduction/Background/Significance: While the prognosis of Acute Myeloid Leukemia (AML) has improved with the advent of novel therapies, sepsis remains a leading cause of morbidity and mortality, primarily due to profound neutropenia and mucosal barrier injuries. This study examines the impact of sepsis on inpatient outcomes and healthcare cost utilization in AML patients using National Inpatient Sample (NIS) data from 2016 to 2020.

Materials and Methods/Case Presentation/Objective: We identified adult patients with a primary diagnosis (I10_DX1) of AML using ICD-10 codes C9200, C9202, C9240, C9242, C9250, C9252, C92Z0, and C92Z2, excluding those with remission codes. Logistic regression was used to evaluate predictors of inpatient mortality, and linear regression was applied to assess the effect of sepsis on length of stay (LOS). A p-value < 0.001 was considered statistically significant, and 95% confidence intervals (CIs) were reported.

Results/Description/Main Outcome Measures: A total of 18,503 AML-related admissions were identified. Overall inpatient mortality was 12.28% (n=2,272). Sepsis was present in 13.36% of cases (n=2,472) and was associated with significantly higher mortality (Odds Ratio [OR] 1.86, CI: 1.75–1.96). Sepsis was also independently associated with prolonged LOS (mean increase of 12.8 days; CI: 12.01–13.58) and higher hospitalization costs ($495,186 vs. $224,023).

Furthermore, sepsis was linked to an increased risk of acute kidney injury (OR 1.4, CI: 1.2–1.4), tumor lysis syndrome (OR 1.8, CI: 1.7–1.9), and ICU admission (OR 2.4, CI: 2.25–2.49), all with p< 0.001.

Demographic variables (age, race, gender, income) and hospital characteristics (region, size, teaching status) were not significantly associated with mortality or LOS.

Conclusions: To our knowledge, this is the largest NIS-based analysis evaluating the impact of sepsis in AML. Sepsis was associated with significantly increased inpatient mortality, longer hospital stays, and substantially higher healthcare costs. Early recognition and prompt initiation of broad-spectrum antibiotics remain essential. Prophylactic antimicrobial and antifungal strategies may also be beneficial for high-risk neutropenic patients. These findings underscore the urgent need for proactive sepsis management in patients hospitalized with AML to decreased mortality and healthcare utilization cost