Disseminated Intravascular Coagulation in Acute Promyelocytic Leukemia Patients - A Retrospective Analysis of Outcomes and Healthcare Burden in US Hospitals.

OBJECTIVE: Acute promyelocytic leukemia (APL) is associated with an elevated risk of developing Disseminated Intravascular Coagulation (DIC). The purpose of this study was to assess the outcomes of hospitalizations related to DIC in APL and their impact on healthcare.

MATERIALS AND METHODS: This is an cross-sectional and retrospective analysis of the National Inpatient Sample Database. We identified adults with APL and categorized them into groups with DIC and without DIC. Our focus areas encompassed in-hospital mortality, length of stay, charges, and DIC-related associations. Unadjusted odds ratios/coefficients were computed via univariable analysis, followed by adjusted odds ratio/coefficients from multivariable analysis that accounted for confounding factors.

RESULTS: Our study revealed that APL patients with DIC had a substantially higher odds ratio (aOR) for mortality (aOR= 6.68 (95% CI: 4.76 - 9.37, p < 0.001), a prolonged length of stay (Coefficient: 10.28 days (95% CI: 8.48 days - 12.09 days, p< 0.001), accompanied by notably elevated total hospital charges (Coefficient:$215,512 (95% CI: $177,368 - $253,656, p<0.001), thereby emphasizing the extended medical care and economic burden. The presence of DIC was associated with increased odds of sepsis, vasopressor support, pneumonia, acute respiratory failure, intubation/mechanical ventilation, and acute kidney injury, reflecting heightened vulnerability to these complications. Patients with DIC demonstrated significantly higher odds ratios for major bleeding, intracranial hemorrhage, GI bleeding, red blood cell transfusion, platelet transfusion, fresh frozen plasma (FFP) transfusion, and cryoprecipitate transfusion), highlighting the pronounced hematological risks posed by DIC.

CONCLUSION: This study uncovers significant associations between DIC in APL and various outcomes, underscoring these conditions' clinical and economic implications. The hematological risks further accentuate patients' vulnerability to bleeding events and the need for transfusions.