Atrial Fibrillation Is Associated with Worse Outcomes in Patients Hospitalized with Neutropenic Fever: A Nationwide Analysis

Background:

Neutropenic fever is a serious complication associated with significant morbidity and mortality in patients receiving chemotherapeutic regimens.Infection is a known adverse prognostic factor among patients with Atrial fibrillation.We sought to determine the impact of Atrial Fibrillation(AF) on hospitalizations for Neutropenic Fever (NF).

Methods:

We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with NF as a principal diagnosis with and without AF as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary results were Acute kidney injury (AKI), Cardiac arrest (CA), Septic shock (CS), Total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders.

Results:

About 111,770 patients were admitted for NF; 8.7% (9,704) had underlying AF. Cohorts with AF vs No AF had a mean age of 70.9 years [CI 70.4 - 71.4] vs 57.4 years [CI 57.1 - 57.7]; male (60.1% vs 46.8%), female (39.3% vs 53.2%); white (86.1% vs 73.2%), black (5.0% vs 9.3%), and Hispanic (4.1% vs 1.0%). Compared to patients without AF, patients admitted with coexisting AF had an increased risk of inpatient mortality (4.0% vs 1.0%, AOR 2.42, 95% CI 1.78 - 3.27, P<0.0001), AKI (16.8% vs 9.8%, P=0.009), CA (0.8% vs 0.2% P=0.004), SS (12.8% vs 4.9% P<0.0001), THC (IRR 1.19, 95% CI 1.10 - 1.29, P<0.0001), and LOS (IRR 1.14, 95% CI 1.09 - 1.19, P<0.0001).

Conclusion:

Patients admitted primarily for NF with co-existing atrial fibrillation had a statistically significant increase in mortality, AKI, CA, SS, THC and LOS. The cohorts in the Atrial fibrillation group were associated with higher economic burden and cost utilization. Additional studies are required to elaborate on the delicate management of this patient population.

No relevant conflicts of interest to declare.