Clinical Factors Associated with Increased Risk of Spinal Cord Compression in Multiple Myeloma Patients: Insights from National Inpatient Sample Database (2016-2020)
Authors: Obomanu Elvis , Jones Colton Frisco , Verinumbe Tarfa , Elom Hilary A , Yusuf Hasiya , Byfield Karecia , Ugwu Chidiebube , Hlaing Swe Swe , Cohn Zachary 
Published: December 2024

Clinical factors associated with increased risk of spinal cord compression in multiple myeloma patients: Insights from National Inpatient Sample database (2016-2020)
Background: Multiple myeloma (MM) is a hematologic malignancy resulting from plasma cell proliferation derived from a single clone. Organ dysfunction is a frequent finding in MM due mainly to plasma cell infiltration; there is also a contribution from plasma cell products and the host cell reaction to these products. A devastating consequence of MM is spinal cord compression (SCC), with attendant neurological deficits. While there are several studies on MM and SCC, there remains a lack of evidence on clinical factors associated with the risk of SCC in MM patients. Our study utilizes the National Inpatient Sample (NIS) database, a comprehensive and reliable source of healthcare data, to address this gap.
Methods: A retrospective analysis of patients diagnosed with MM was conducted in the NIS database from 2016 to 2020. Our study sample consisted of patients diagnosed with MM identified using the tenth revision of the International Classification of Diseases (ICD-10 code C9000-C9002). Concurrent diagnosis of SCC was our study outcome (ICD-10 codes G9520 and G9529). Exposure variables analyzed included age, sex (male, female), race (white, black, Hispanic, and others), insurance status (private, Medicare, Medicaid), hypercalcemia, anemia, protein energy malnutrition (PEM), long-term steroid use, hypoalbuminemia, hemodialysis, length of hospital stays, and comorbidities on the patient's record (measured using the Charlson Comorbidity Index). Descriptive statistics were used to characterize the study sample. Multivariable logistic regression was used to assess factors associated with SCC.
Results: Our analysis included 115,387 patients with MM admitted between 2016 and 2020. Most patients were white (61.7%), male (55.55%), and aged 60-79 (60.5%). Of these patients, 1.44% (1666/115,387) had an SSC diagnosis. In a multivariate logistic regression model adjusting for patient and hospital factors, increased risk of SCC in MM patients was significantly associated with black race (aOR 1.25; 95% CI: 1.10-1.61) and Hispanic race (aOR 1.36; 95% CI: 1.14-1.61) compared to white race, hypercalcemia (aOR 2.21 95% CI: 1.91-2.56), Charlson Comorbidity Index (aOR 1.12; 95% CI: 1.09-1.14), and prolonged length of stay (aOR 1.02; 95% CI: 1.02-1.03). However, hemodialysis (aOR 0.24; 95% CI: 0.18-0.32), age 60-79 years (aOR 0.71; 95% CI: 0.62-0.81), and Medicare insurance compared to private insurance (aOR 0.74; 95% CI: 0.65-0.85) were associated with decreased risk of SCC in MM. The association of other clinical factors such as anemia (aOR 1.07; 95%CI: 0.92-1.23), PEM (aOR 1.09; 95%CI: 0.94-1.26), long-term steroid use (aOR 1.07; 95%CI: 0.82-1.40), and risk of SCC was not statistically significant.
Conclusion: Our study found significant associations between race, hypercalcemia, number of comorbidities, and prolonged length of hospital stay with an increased risk of SCC in patients admitted with MM. These findings may be crucial in the development of predictive tools that can be used to determine the risk of SCC in MM patients. The inconclusive associations of clinical factors such as PEM, anemia, and increased steroid use with increased risk of SCC in MM patients highlight the need for further longitudinal cohort studies. This study's findings have the potential to significantly impact the management of MM patients at risk of SCC, guiding future research and clinical practice.