(512) Factors Causing Heightened Mortality in Leukemia Patients With COVID-19

Introduction: COVID-19 presents more severely in Leukemia compared to solid tumors (OR 1.6, p< 0.05). Several factors may exacerbate the severity of COVID-19 in Leukemia, including aggressive disease, immune dysfunction, delayed seroconversion, and prolonged hospitalization. We aim to identify factors associated with mortality among 1,200 adults with Leukemia admitted for COVID-19 in the United States.

Methods: We analyzed the National Inpatient Sample database (2020-2021) to include adults (≥18 years) with Leukemia admitted primarily for COVID-19 using ICD-10 codes. Descriptive statistics and multivariate regression analysis were performed with a p-value set at ≤0.05. The regression results were reported as adjusted odds ratios (aOR) with a 95% confidence interval.

Results: Out of 189,716 Leukemia admissions, the rate of mortality in patients with COVID-19-related admissions was 14.7%, compared to just 5.5% in all-cause admissions. Multivariate regression analysis reported a 75% increase in the odds of mortality (aOR 1.8, 95% CI 1.6-1.9, p≤0.05) in COVID-19 admissions. We were able to identify several factors associated with increased mortality (p≤0.05), including age ≥65 years (aOR 3.4, 95% Cl 2.8-4.1), acute respiratory failure (aOR 19.3, 95% Cl 14.1-26.5), severe sepsis (aOR 4.9, 95% Cl 3.7-6.6), myocardial infarction (aOR 2.2, 95% Cl 1.6-3), acute kidney injury (aOR 2.7, 95% Cl 2.3-3.2), invasive ventilation (aOR 11.6, 95% Cl 7.3-18.3) and vasopressor usage (aOR 4.1, 95% Cl 2.6-6.4). Gender did not contribute to mortality (p>0.05). Additionally, higher mortality in patients with Acute Myeloid Leukemia (mortality 6.1% vs survival 3.8%, p< 0.001), Chronic Myeloid Leukemia (4.8% vs 3.6%, p≤0.05), and Chronic Lymphocytic Leukemia (35.2% vs 27.8%, p< 0.0001) subtypes were found.

Conclusions: Leukemia patients admitted for COVID-19 who develop hemodynamic instability and respiratory distress during the disease course have an increased risk of mortality. Additionally, monitoring sepsis and treating secondary bacterial infections is essential in reducing the burden of mortality. A multi-specialty treatment strategy to address cardiac, renal, and critical care concerns simultaneously is recommended to provide comprehensive management to such patients.