Assessing the Impact of COVID-19 on Outcomes of Patients with Acute Myeloid Leukemia

Background:

Patients with acute myeloid leukemia (AML) are particularly susceptible to infections due to qualitative and quantitative deficiencies in granulocytes and the use of immunosuppressive therapies. There is currently a dearth of comprehensive data on the impact of COVID-19 infection on the in-hospital outcomes of patients with AML. We examined the association between COVID-19 and hospital-associated outcomes among patients with a diagnosis of AML.

Methodology:

Healthcare Cost and Utilization Project–National Inpatient Sample (HCUP-NIS) (2020-2021) was queried to identify adult patient (aged ≥ 18 years) hospitalizations with a primary diagnosis of AML. The cohort was dichotomized based on the presence of COVID-19 infection. The primary outcomes studied were in-hospital mortality, length of stay, hospital charges. Secondary outcomes included end-organ failures and intensive care unit (ICU) admissions. Multivariable logistic and linear regression models were performed, adjusting for patient characteristics to evaluate outcomes. An alpha error of 0.05 was accepted for all analyses.

Results:

Of 42,320 AML hospitalizations included in the study, 500 (1.2%) had concomitant COVID-19 infection. The mean age was 57 years in patients with COVID and 63 years in those without COVID (P=0.002). Patients with AML and concurrent COVID-19 infection had significantly higher odds of in-hospital mortality [adjusted odds ratio (aOR) 2.03, 95% confidence interval (CI) 1.22-3.37, P = 0.006] and prolonged hospital stays (> 5 days) [aOR 1.79 (1.02-3.14), P=0.04]. There was a tendency towards higher hospitalization costs in the COVID-19 cohort, however, it was not significant [β Coefficient: $51,724, 95% CI: $-57,106- 160,554), P=0.35]. Additionally, AML patients with COVID-19 infection had significantly higher odds of acute respiratory failure (aOR: 2.09, 95% CI: 1.31-3.32, P=0.002), severe sepsis (aOR:1.92, 95% CI: 1.07-3.46, P=0.003), ICU admissions (aOR:2.5, 95% CI:1.46-4.28, P=0.001), vasopressor use (aOR:2.76, 95% CI:1.34-5.69, P=0.006) and mechanical ventilation utilization (aOR:2.53, 95% CI:1.43-4.50, P=0.001).

Conclusion:

Patients with AML admitted with COVID-19 infection had higher odds of in-hospital mortality and were more likely to develop complications such as acute respiratory failure, necessitating a higher level of care. They also experienced longer hospital stays. The development of COVID-19 in patients with AML likely results in poor outcomes due to a dysregulated immune response and hyperinflammation. Additionally, previous studies have demonstrated impaired humoral responses following COVID-19 vaccination in patients with hematologic malignancies and increased vulnerability due to emergence of new variants in previously vaccinated individuals (Langerbeins & Hallek, 2022; Harris, Vijenthira, Ong, Baden, Hicks, & Baird, 2023). Our findings emphasize the need for heightened precautions in this high-risk population despite the relaxation of COVID-19 restrictions.