(477) A Retrospective Analysis on Factors Influencing Mortality in Leukemia and Acute Kidney Injury

Introduction: Acute kidney injury (AKI) is seen in 7.5% of patients with hematological malignancies with Leukemia being one of the top three cancers. In patients with hematological malignancies the mortality rises from 5.1% to 24.8% as they progress from stages 1 through 3. We aimed to identify factors associated with mortality in Leukemia patients admitted for AKI.

Methods: We conducted a retrospective analysis using the National Inpatient Sample Database (2018-2021). Adults with Leukemia primarily admitted with AKI were identified using the ICD-10 codes. Confounding was reduced by propensity matching and multivariate regression analysis. A p-value of ≤0.05 was set.

Results: Of 388,449 Leukemia patients, 9,834 had AKI, a higher proportion than non-leukemia patients (2.5% vs 1.8%; p< 0.05). Mortality in the AKI cohort was lower than those without AKI (4.2% vs 5.4%; adjusted Odds Ratio [aOR] 0.04, 95% CI 0.0 to 0.4; p< 0.05). In the AKI cohort, those aged over 75 years exhibited a higher mortality (p < 0.001). Race, gender, hematopoietic stem cell transplant, and inpatient hemodialysis did not alter mortality (p>0.05). However, we identified increased mortality in patients (p < 0.05) with severe sepsis (aOR 38.2; 95% CI 24.6 to 59.6), metabolic encephalopathy (aOR 3.3; 95% CI 2.6 to 4.1), and thrombocytopenia (aOR 1.8; 95% CI 1.4 to 2.3). Additionally, those who faced mortality (p < 0.05) required more vasopressors (9.6% vs 0.4%) and invasive ventilation (11.5% vs 0.3%) than those who survived. We also identified AKI in Chronic Myeloid Leukemia (CML 2.6%), followed by Chronic Lymphocytic Leukemia (2.4%), and Acute Myeloid Leukemia (AML 0.9%), with the highest mortality observed in AML (7%) and CML (5.7%).

Conclusions: Leukemia patients with acute kidney injury combined with sepsis, encephalopathy, or thrombocytopenia have high mortality. Bone marrow dysfunction in Leukemia predisposes patients to sepsis and thrombocytopenia, while the hyperuremic state in renal failure leads to metabolic disturbances and thrombocytopenia. A multidisciplinary team to prevent renal failure, identify and treat bone marrow dysfunction, and manage metabolic alterations is crucial in improving outcomes.