Antwi-Amoabeng Daniel, Beutler Bryce D, Neelam Vijay, Ulanja Mark
Department of Internal Medicine, Christus Ochsner St. Patrick Hospital, Lake Charles, LA 70602, USA.
Department of Radiology, University of California, San Francisco, CA 94143, USA.
Clin Pract. 2025 Jun 25;15(7):117. doi: 10.3390/clinpract15070117.
BACKGROUND/OBJECTIVES: Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited.
We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized leukemia patients were identified using ICD-10 codes. Trends in the incidence of venous thromboembolism (VTE) and bleeding were assessed across the years, and multivariable logistic regression models were used to evaluate the predictors of VTE and bleeding. We assessed the influence thromboembolic and hemorrhagic complications on length of stay, cost, and mortality outcomes.
Among 430,780 leukemia hospitalizations, the overall incidence of VTE was 5.4% and remained stable throughout the study period ( = 0.09), while hemorrhagic events = 5.6%) showed a significant upward trend ( = 0.01). Cerebrovascular accidents, central venous catheter insertion, and protein calorie malnutrition (PCM) were significant predictors of both VTE and hemorrhage. PCM demonstrated a dose-dependent relationship with both complications. VTE was associated with a 33.5% increase in length of stay (LOS) and a 35% increase in cost of care (COC). Hemorrhage was associated with 23.2% increase in LOS and 32.6% increase in COC. Only hemorrhagic events were independently associated with increased mortality (adjusted OR 2.88, < 0.001).
The incidence of VTE in hospitalized leukemia patients has remained stable while hemorrhagic complications have increased significantly. Nutritional status represents a potentially modifiable risk factor for both VTE and bleeding complications. The competing risk between thrombosis and hemorrhage varies with age and nutritional status, suggesting the need for nuanced thromboprophylaxis strategies in this vulnerable population.
背景/目的：静脉血栓栓塞症（VTE）和重大出血事件是住院白血病患者的严重并发症，但对其流行病学、预测因素以及对临床结局影响的当代分析仍然有限。
我们使用2016年至2020年的全国住院患者样本（NIS）数据库进行了一项横断面研究。使用国际疾病分类第十版（ICD - 10）编码识别住院白血病患者。评估多年来静脉血栓栓塞症（VTE）和出血发生率的趋势，并使用多变量逻辑回归模型评估VTE和出血的预测因素。我们评估了血栓栓塞和出血并发症对住院时间、费用和死亡率结局的影响。
在430,780例白血病住院病例中，VTE的总体发生率为5.4%，在整个研究期间保持稳定（P = 0.09），而出血事件（5.6%）呈显著上升趋势（P = 0.01）。脑血管意外、中心静脉导管插入和蛋白质热量营养不良（PCM）是VTE和出血的重要预测因素。PCM与两种并发症均呈剂量依赖关系。VTE与住院时间（LOS）增加33.5%和护理费用（COC）增加35%相关。出血与LOS增加23.2%和COC增加32.6%相关。只有出血事件与死亡率增加独立相关（调整后的比值比为2.88，P < 0.001）。
住院白血病患者中VTE的发生率保持稳定，而出血并发症显著增加。营养状况是VTE和出血并发症的一个潜在可改变的危险因素。血栓形成和出血之间的竞争风险因年龄和营养状况而异，这表明在这一脆弱人群中需要细致入微的血栓预防策略。
