Clinical Outcomes for Hematopoietic Stem Cell Transplant Recipients with Thrombocytopenia: An Analysis of the National Inpatient Sample
Authors: Thor Danielle C , Elias Tony , Polineni Vineet , Brik Ben 
Published: December 2024

Background: As hematopoietic stem cell transplant (HSCT) grows in accessibility and utility, it remains imperative to understand outcomes for its recipients. Limited data is available on the comorbid correlations for this steadily increasing patient population. We sought to examine the National Inpatient Sample (NIS) database to describe in-hospital outcomes among patients who received a HSCT and developed thrombocytopenia.

Methods: Data were extracted from the NIS Database from 2019 and 2020. The NIS was searched for hospitalizations of all patients greater than 18 years old who had previously received a HSCT and were hospitalized thereafter. We then analyzed the outcomes of these patients who developed thrombocytopenia. Multivariate logistic regression analysis was used to adjust for confounders; SPSS software was used for statistical analysis. The primary outcome was inpatient mortality and secondary outcomes are listed below.

Results: This study included 8,302 patients who had received a HSCT, of which 1470 (17.7%) were found to have thrombocytopenia. Thrombocytopenic recipients of a HSCT had higher prevalences of smoking (21.2% versus 20.5%, p&lt;0.001), hypertension (26.1% versus 23.7%, p&lt;0.001), and chronic kidney disease (23.8% versus 21.3%, p&lt;0.001). Multivariate regression demonstrated that thrombocytopenic recipients of a HSCT had higher inpatient mortality (OR 1.378, CI 1.291-1.471, p&lt;0.001). On secondary analysis, thrombocytopenic HSCT recipients were found to be more likely to have anemia (OR 1.272, CI 1.254-1.291), systemic lupus erythematosus (OR 1.143, CI 1.003-1.303, p&lt;0.001), non-alcoholic fatty liver disease (OR 1.265, CI 1.163-1.377, p&lt;0.001), peripheral artery disease (OR 1.249, CI 1.173-1.329, p&lt;0.001), hypertension (OR 1.242, CI 1.216-1.270, p&lt;0.001), acute kidney failure (OR 1.284, CI 1.253-1.315, p&lt;0.001), all-cause arrhythmias (OR 1.249, CI 1.204-1.295, p&lt;0.001), all-cause shock (OR 1.356, CI 1.243-1.478, p&lt;0.001), acute pancreatitis (OR 1.148, CI 1.065-1.237, p&lt;0.001), all-cause heart block (OR 1.202, CI 1.135-1.274, p&lt;0.001), pericarditis (OR 1.338, CI 1.236-1.447, p&lt;0.001), sepsis (OR 1.293, CI 1.264-1.322, p&lt;0.001), hematuria (OR 1.273, CI 1.191-1.360, p&lt;0.001), esophagitis (OR 1.198, CI 1.174-1.223, p&lt;0.001), Crohn's disease (OR 1.206, CI 1.050-1.386, p&lt;0.001), systemic sclerosis (OR 1.171, CI 1.032-1.330, p&lt;0.001), coagulopathies (OR 1.520, CI 1.418-1.629, p&lt;0.001), chronic pulmonary disease (OR 1.190, CI 1.156-1.225, p&lt;0.001), pulmonary hypertension (OR 1.292, CI 1.209-1.382, p&lt;0.001), severe liver disease (OR 1.239, CI 1.177-1.303, p&lt;0.001), acute heart failure (OR 1.239, CI 1.208-1.272, p&lt;0.001), and myocardial infarction (OR 1.206, CI 1.158-1.225, p&lt;0.001).

Conclusion: In this nationally-representative, population-based retrospective cohort study, thrombocytopenic patients who have received a HSCT and were subsequently hospitalized were associated with higher mortality and worse outcomes.