Abstract
Title: The Effect of Underlying Hereditary Hemolytic Disorders on Hospital Resource Utilization in Babesiosis-Associated Hospitalizations: A National Inpatient Sample Analysis 2016–2022 Authors: Heng Jiang, MD, MBBS1, Deepika Dilip, MPH, MS2, Amit Krishnan, MD1, Christopher Poletes, MD1, Kangning Peng, MD3,4, Jaishvi Eapen, MBBS5, Marina Keller, MD5, Amir Steinberg MD6
Department of Medicine, Westchester Medical Center, Valhalla, NY
School of Medicine, New York Medical College, Valhalla, NY
Department of Medicine, Cambridge Health Alliance, Cambridge, MA
Harvard Medical School, Harvard University, Boston, MA
Division of Infectious Disease, Department of Medicine, Westchester Medical Center, Valhalla, NY,
Division of Hematology/Oncology, Department of Medicine, Westchester Medical Center, Valhalla, NY
Background: Nonimmune hemolytic anemia is a hallmark clinical feature of tick-borne infection babesiosis. The impact of underlying hemolytic disorders—particularly hereditary subgroups—on babesiosis associated hospitalization outcomes remains unknown. Given the vulnerability of erythrocytes in hereditary hemolytic disorders (HHD) patients, we investigated the association between HHD and hospital resource utilization among babesiosis-associated admissions using a nationally representative dataset.
Methods: The National Inpatient Sample (NIS) from 2016-2022 was queried to identify all hospitalizations with babesiosis diagnosis. HHD was defined by flagging conditions such as hereditary spherocytosis, enzyme deficiencies, thalassemia, etc. Outcomes of interest were in-hospital mortality (IHM), length of stay (LOS), and total charges (TCHG). Two-sample t test and two-sample Wilcoxon rank-sum test were used for continuous variables. Chi-square test was used for categorical variables. Logistic regression and linear regression were used for multivariate outcome analyses. All disease diagnosis were identified by International Classification of Diseases 10th Version (ICD-10) codes.
Results: A total of 1,968 (weighted n=9,840) babesiosis associated hospitalizations were identified, with most cases being in northeast region (88.7%). 10.7% (weighted n=1,050) of them had HHD, and they were more likely to be male (74.29%, p=0.019), white (66.02%, p=0.001), and treated at large urban teaching hospitals (83.33%, p=0.005). A subgroup of 979 (weighted n=4,895) hospitalizations was identified with primary diagnosis of babesiosis, and 92.54% of them were in the northeastern hospitals. HHD patients were younger (mean age 64.4 vs 67.6 years, p=0.047), had longer LOS (+5.8 vs +4.6 days, p=0.002), and higher TCHG (+$59,414 vs +$43,913, p=0.007) compared to those without. HHD was also associated with higher rates of IHM (5.0% vs 0.5%, p<0.001), AKI (40% vs 25%, p<0.001), and more severe illness (p<0.001).
For hospitalizations with primary babesiosis diagnosis, weighted multivariate logistic regression showed that HHD (OR 14.3, 95% CI 3.96-51.7, p<0.001), acute kidney injury (AKI) (OR 13.1, 95% CI 1.3-132.9, p=0.029), Hispanic patients (OR 8.0, 95% CI 1.1-56.7, p=0.038) were associated with increased IHM. HHD and AKI were independently associated with longer LOS (+0.7 days, 95% CI 0.03-1.53, p=0.043; +1.8 days, 95% CI 1.08-2.44, p<0.001). Asian patients and urban teaching hospital were also correlated with longer hospital stay (+1.82 days, 95% CI 0.13-3.52, p=0.035; +1.10 days, 95% CI 0.25-1.94, p=0.011). AKI, Hispanic, Asians and larger teaching suburban/urban hospitals were associated with higher TCHG (p<0.05). HHD also showed increased TCHG in the regression model, however it was not statistically significant (+$7231, 95% CI -5289-19751, p=0.257).
Conclusions: Among patients hospitalized with primary babesiosis, underlying HHD and AKI were associated with greater healthcare utilization, suggesting HHD may indicate an independent risk factor for babesiosis associated hospitalizations. Racial profile might also play a role in hospital outcomes. Recognition of these risk factors may aid in early triage and tailored supportive care in babesiosis-endemic regions.
