Clinical and Economic Outcomes of Diffuse Follicular Center Lymphoma: An Analysis Using the National Inpatient Sample (NIS) - 2021
Authors: Rajarajan Srinishant , Babu Kalaivani , Chattaraj Asmi , Ramesh Nithya , Ramanan Sruthi P , Correa Amit , Roy Arya Mariam , Ayanambakkam Attanathi Adanma Anji 
Published: December 2024

Background: Diffuse Follicular Center Lymphoma (DFCL) is a subtype of non-Hodgkin lymphoma characterized by malignant transformation of follicular center B-cells. It presents a significant clinical challenge due to its heterogeneity in presentation and outcomes. Understanding the demographic, clinical characteristics, and economic impacts of DFCL can provide valuable insights for healthcare providers and policymakers to improve patient care and resource allocation. This study aims to analyse these aspects using data from the National Inpatient Sample (NIS), a large, nationally representative database of hospital inpatient stays in the United States.

Methods: We identified patients with DFCL using ICD-10 code C82.5. Descriptive statistics and multivariable regression analyses were performed to assess primary and secondary outcomes, adjusting for covariates including age, sex, race, median household income for patient ZIP code, Charlson comorbidity index, weekend admission status, hospital region, teaching status of hospital, and hospital bed size. The primary outcome was in-hospital mortality, while secondary outcomes included hospital length of stay (LOS) and total hospitalization charges (TOTCHG).

Results: Out of the 6,666,752 hospitalisations in the sample, 280 were identified with DFCL. Among these patients, 60.71% were male, and 39.29% were female. The racial composition was predominantly white (78.57%), followed by black (3.57%), Hispanic (12.5%), Asian or Pacific Islander (3.57%), and other races (1.79%). The mean age of the DFCL patients was 68.39 years.

The in-hospital mortality rate for these patients was 12.5% (95% CI: 5.99%-24.26%). Adjusted logistic regression revealed that age (OR: 2.26, 95% CI: 1.18-4.32, p=0.014) and being treated in a teaching hospitals (OR: 2299.42, 95% CI: 3.21-1648837, p=0.021) were significantly associated with higher mortality. Sex, race, median household income for patient ZIP code, Charlson comorbidity index, weekend admission status, hospital region, and hospital bed size did not significantly predict mortality.

Regarding the length of stay, the mean hospital LOS for DFCL patients was 7.57 days (95% CI: 5.61-9.54). Adjusted regression analysis indicated that being treated in hospitals located in the Midwest was associated with a significantly shorter LOS (Coefficient: -8.49, 95% CI: -16.12 to -0.87, p=0.029). Negative findings for LOS suggest that sex, race, median household income for patient ZIP code, Charlson comorbidity index, weekend admission status, teaching status of hospital, and hospital bed size were not significant predictors. The mean total hospitalization charge for DFCL patients was $120,475 (95% CI: $63,362 - $177,588). Adjusted regression did not find significant predictors for hospitalization charges. Negative findings indicate that age, sex, race, median household income for patient ZIP code, Charlson comorbidity index, weekend admission status, hospital region, teaching status of hospital, and hospital bed size did not significantly predict total hospitalization charges.

Conclusion: Our study provides a comprehensive analysis of DFCL in hospitalized patients, highlighting significant predictors of mortality and hospital stay. The results indicate that older age and being treated in teaching hospitals are associated with higher in-hospital mortality. Additionally, treatment in hospitals located in the Midwest is associated with shorter lengths of stay. However, many socioeconomic factors and hospital characteristics, such as sex, race, income, comorbidity index, and bed size, were not significant predictors of mortality, length of stay, or hospitalization charges. These negative findings suggest that other unmeasured variables may play a crucial role in these outcomes. Future research should aim to identify these factors and further investigate the complexities of DFCL treatment to improve patient care and resource allocation.