Use of daunorubicin and cytarabine in adults with acute myeloid leukemia and associated risk factors for inpatient mortality: National inpatient sample review.
Authors: Pagidipally Alekhya , Sharma Shivani , Chennapragada Suma Sri , Dandwani Mehndi , Ramphul Kamleshun , Verma Renuka , Sanikommu Sailaja , Arti Fnu , Kumar Vijay , Sombans Shaheen , Ramphul Yogeshwaree , Mejias Stephanie G. , Dhillon Balkiranjit Kaur , Lohana Petras 
Published: June 2023

e19029

Background: According to American Cancer Society’s 2023 estimates, Acute Myeloid Leukemia (AML) is the most common leukemia in adults, involving up to 34% of new cases in the United States. The conventional cytotoxic therapy in AML involves induction therapy with cytarabine and an anthracycline daunorubicin or idarubicin. The purpose of this study was to assess patient traits and disease variables augmenting mortality risk in AML patients treated with cytarabine and daunorubicin. Methods: We used the 2016-2020 National inpatient sample (NIS), via SPSS 29. 0, to find adult patients with a diagnosis of AML and use of Daunorubicin/Cytarabine. Several patient characteristics and comorbidities such as sex, race, obesity, diabetes, and hypertension were identified. The mortality rate among these patients were estimated and logistic regression models were used to report risk factors of mortality and their associated adjusted odds ratio and 95% confidence interval (95% CI). Results: Our analysis found 6695 cases of AML using Daunorubicin/Cytarabine. Among them 47.1% were above the age of 60, 45.7% were covered under private insurance, 71.8% were of White race, 54.4% were males and 31.8% were smokers. 10.3% of patients were admitted on the weekend. Various comorbidities were seen including diabetes (14.7%), obesity (13.0%), hypertension (32.9%), history of old myocardial infarction (2.5%), and cirrhosis (3.0%). While admitted, patients experienced a range of side effects and complications including fever (2.2%), nausea and vomiting (9.4%), weakness or malaise or fatigue (4.4%), septicemia (18.6%), Acute Kidney Injury (AKI) (18.5%), cardiac dysrhythmias (16.0%), cardiogenic shock (0.5%) and secondary or unspecified thrombocytopenia (21.0%). Unfortunately, 415 patients died (6.2%) during hospitalization. A higher risk of mortality was seen in weekend admissions (aOR 1.687, 95% CI 1.227-2.318, p < 0.01), those who developed septicemia (aOR 7.859, 95% CI 6.076-10.164, p < 0.01), and AKI (aOR 3.095, 95% CI 2.396-3.998, p < 0.01). Mortality risk was also higher in those with cirrhosis (aOR 6.367, 95% CI 4.139-9.794, p < 0.01) and age more than 60 (aOR 3.174, 95% CI 2.275-4.428, p < 0.01). However, a lower mortality risk was seen in patients with hypertension (aOR 0.689, 95% CI 0.518-0.918, p = 0.011). Conclusions: Various factors such as weekend admissions, septicemia, AKI, cirrhosis, and age > 60 were associated with poorer outcomes while hypertensive patients had a lower mortality rate. The drawbacks of this study were that complications and side effects couldn't be quantified in proportion to doses or number of cycles received post induction with or without consolidation therapy with cytarabine and daunorubicin. Further studies in clinical settings should investigate the various disparities observed in our study.