Outcomes of Acute Kidney Injury Among Hospitalized Patients with Sepsis and Acute Myeloid Leukemia: A National Inpatient Sample Analysis

Abstract

Background: Sepsis in patients with acute myeloid leukemia (AML) is one of the causes of acute kidney injury (AKI). There are no available data on the outcomes of AML-related AKI patients. Methods: We researched the 2016-2020 National Inpatient Sample (NIS) database to collect data on hospitalizations of patients ≥18 years old with sepsis and AML. These admissions were divided into two weighted groups, with and without AKI. A multivariable logistic regression was used with adjustment for possible confounders to generate the adjusted odds ratios for the outcomes of the study. A p-value of <0.05 was considered significant. The primary outcome was all-cause inpatient mortality. Secondary outcomes were septic shock, fluid and electrolyte disorders, length of stay (LOS), vasopressor support, and the requirement for mechanical ventilation. Results: Out of 288,435 hospital admissions of patients with sepsis and AML, 61,955 (21.4%) had AKI. Patients with AKI were older (mean age 66.1 vs. 60.4 years), males (63.1% vs. 52.8%), and more Black individuals were affected (12% vs. 9.2). They also had more comorbidities but had a significantly higher percentage of diabetes mellitus, congestive heart failure, cardiac arrhythmias, cerebrovascular disease, and chronic kidney disease. Tumor lysis syndrome was present in 11.1%. Compared to patients without AKI, patients with AKI had longer LOS days (15.4 ± 18 vs. 10.8 ± 13.1, p < 0.001. Multivariable analysis showed that the patients with AKI had higher odds of mortality (OR: 3.8, 95% CI: 3.6-4.1, p < 0.001). They also had a higher risk for fluid and electrolyte disorders (OR: 2.2, 95% CI: 2.1-2.4, p < 0.001), septic shock (OR: 6.3, 95% CI: 5.7-6.9, p < 0.001), vasopressor requirement (OR: 5.0, 95% CI: 4.3-5.8, p < 0.001), and mechanical ventilation (OR: 5.2, 95% CI: 4.7-5.7, p < 0.001). Conclusions: AKI in patients with sepsis and AML was associated with higher mortality compared to sepsis alone, as well as other complications. Further large studies are required to identify factors that could improve outcomes.

Keywords: acute kidney injury (AKI); acute myeloid leukemia (AML); mortality; sepsis.

Figure 1

Patient selection (weighted flow chart). Abbreviations: AKI—acute kidney injury.