Title

Sepsis-Related Outcomes and Healthcare Burden in Chronic Lymphocytic Leukemia Patients with Atrial Fibrillation: A National Database Study

Authors

Adamsegd Isac Gebremedhen, Mamdouh Souleymane, Thomas Wright, Ahmad T. Mahdi, Samson T. Teka, Stephen Roy, Eva D. Patton-Tackett

Introduction

Atrial fibrillation (AF) is commonly present in patients with chronic lymphocytic leukemia (CLL) at diagnosis, with the risk of new-onset AF increasing over time due to age-related comorbidities (e.g., hypertension, valvular heart disease) and the use of Bruton’s tyrosine kinase inhibitors (BTKIs) like ibrutinib. AF in CLL patients is associated with higher cardiac-related mortality and stroke risk. However, its specific impact on sepsis outcomes in CLL patients remains underexplored. This study aims to fill this gap by evaluating how AF influences sepsis-related outcomes in CLL patients.

Methods

We identified adult patients with CLL hospitalized for sepsis as the principal diagnosis between 2018 and 2021 using ICD-10 codes from the National Inpatient Sample. We divided the cohort by the presence or absence of AF and applied complex sampling weights to ensure national representation. The primary outcome was all-cause mortality, with several secondary outcomes also analyzed. To compare outcomes between the groups, we used multivariate regression models, setting statistical significance at p < 0.05.

Results

We identified a total of 44,805 adults with CLL who were admitted with a principal diagnosis of sepsis from 2018 to 2021. Among these, 14,965 patients (33.4%) had a concurrent diagnosis of AF. The mortality rate was 15.1% in the entire cohort and 17.5% in the AF group. Patients in the AF group were older (78.9 vs. 73.6 years, p < 0.001) and had a higher proportion of males (68.4% vs. 62.6%, p = 0.01) and white individuals (88.7% vs. 80.2%, p < 0.001). They also had a higher comorbidity burden, with more patients having a Charlson Comorbidity Index of 3 or above (89.9% vs. 78.1%, p < 0.001). Patients with AF had higher odds of all-cause mortality, with an adjusted odds ratio (aOR) of 1.37 (95% confidence interval [CI] 1.21–1.57). They also had higher odds of experiencing acute kidney injury (aOR 1.19, 95% CI 1.07–1.32) and requiring renal replacement therapy (aOR 1.36, 95% CI 1.05–1.76). Furthermore, they faced higher odds of experiencing respiratory failure (aOR 1.32, 95% CI 1.19–1.46), requiring mechanical ventilation (aOR 1.47, 95% CI 1.22–1.78), experiencing septic shock (aOR 1.77, 95% CI 1.57–1.99), and needing vasopressor support (aOR 1.37, 95% CI 1.08–1.77). Additionally, patients with AF had longer hospital stays (8.0 vs. 7.7 days), with an adjusted incidence rate ratio (aIRR) of 1.09 (95% CI 1.03–1.14), and higher hospitalization charges ($98,424 vs. $97,383), with an aIRR of 1.13 (95% CI 1.06–1.21).

Conclusion

AF in CLL patients hospitalized for sepsis is linked to higher mortality, increased complications, and greater healthcare resource utilization. These findings highlight the need for more effective management strategies to improve outcomes and reduce healthcare costs in this population. Future research should focus on understanding the underlying mechanisms that connect AF to these negative outcomes, with the goal of identifying targeted interventions to enhance patient care.

References

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