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Impact of Invasive Fungal Infections on Mortality, Length of Hospital Stay, and Costs in Allogeneic Hematopoietic Stem Cell Transplant Patients

Track: Poster Abstracts
Saturday, March 1, 2014, 6:45 PM-7:45 PM
Longhorn Hall E (Exhibit Level 1) (Gaylord Texan)
Jenny Cai, MD, PHD , Anti-infective/Vaccine TA, Safety Evaluation and Reporting, Worldwide R&D, Pfizer Inc., Bridgewater, NJ
Angela Prehn, PhD , 2. Public Health Program, School of Health Sciences, Walden University, Minneapolis, MN
Haran Schlamm, MD , HTS Pharma Consulting, LLC, New York, NY
Massimiliano Mucci, MD , Anti-infective/Vaccine TA, Safety Evaluation and Reporting, Worldwide R&D, Pfizer Inc., Milan, Italy
Aimee Ferraro, PhD , 2. Public Health Program, School of Health Sciences, Walden University, Minneapolis, MN
Background: Over the last decade, unrelated donors have become a vital resource for hematopoietic stem cell transplantation (HSCT) and the number of allogeneic HSCT (allo-HSCT) has increased significantly. While invasive fungal infections (IFIs) remain major concerns in these patients, data regarding impact of these infections on mortality, length of hospital stay, and hospital charge are limited in the United States at a national level. Additionally, with many updates in transplant practice, risk factors for IFIs in these patients may have changed.

Methods: To assess risk factors and impact of IFIs on mortality, length of hospital stay, and hospital charges, a quantitative and cross-sectional design was used to analyze secondary data from the 2010 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP NIS) database. Chi-square test, Mann-Whitney test, and multiple logistic regression were used for statistical analyses.

Results: A total of 5,753 weighted hospital records of allo-HSCT were identified with a mean age of 44.8 ± 19.1 years. The IFI rate was 7.8% (451), with aspergillosis (30.6%) and candidiasis (9.6%) as the two most common IFIs. Compared to patients without IFIs, patients with IFIs had nearly 5 times higher mortality (25.1% vs. 5.1%), longer hospital stays, and higher hospital charges (p < .01). Multiple regression analyses on risk factors confirmed presence of graft-versus-host disease as a recognized risk factor for IFIs. However, younger age, female gender, and related donors were also identified as risk factors for IFIs in this analysis. The underlying reasons for these unexpected findings will be explored.

Conclusions: An analysis of a large U.S. inpatient database confirmed that allo-HSCT patients with IFIs have higher mortality and higher health care costs. The risk factors for IFIs have been identified that could enable better management and control of these infections.

Disclosures:
J. Cai, Pfizer, Director: Salary

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