Association of Palliative Care Involvement and Infectious Complications in Hospitalized Multiple Myeloma Patients - National Inpatient Database Study

Background

Pain is the most common symptom in multiple myeloma (MM), and palliative care (PC) involvement often focuses on symptom management. Improvement in MM treatment has increased survival rates, consequently increasing symptom burden and comorbidities. Infection is a major concern in hospitalized MM patients due to their immunocompromised state. Evaluating the association between PC involvement and infectious complications in hospitalized MM patients can provide insights into quality of care and patient outcomes.

Methods

A retrospective cohort study using the ICD10 codes from the National Inpatient Database (2016-2020) was performed with STATA BE software. Chi square test was used for crude analysis and logistic regression was used to adjust for confounders for categorical variables. Z score was calculated to assess the difference between the Log Odds Ratios of two separate analyses. Results were adjusted for age, gender, race, insurance, hospital size and location, nicotine and alcohol use, diabetes, heart failure, chronic kidney disease, obesity, bone marrow transplantation (BMT), chemotherapy, immunotherapy, neutropenia, hypogammaglobulinemia, and myeloma type (multiple myeloma, plasma cell leukemia, solitary and extramedullary plasmacytoma).

Results

This study included 118,369 hospitalized MM patients with a mean age of 69.49土11.46 years and 44.31% females. Palliative care involvement was significantly associated with infection [OR 1.15; 95%CI 1.45-1.58] and in-hospital mortality [OR 15.43; 95%CI 14.55-16.36] likely because of the same ICD 10 code used for PC and hospice care. Delayed involvement of PC in patient care primarily for goals of care conversations might also be contributory. Interestingly, the association between infection and mortality was significantly lower [z-score 6.76; p value<0.001] when PC was involved [OR 2.23; 95%CI 2.04-2.44] as compared to when PC was not involved [OR 3.41; 95%CI 3.14-3.71]. When PC was involved for MM patients with infection, BMT [OR 0.87; 95%CI 0.76-0.99] and chemotherapy [OR 0.61; 95%CI 0.53-0.71] were associated with significantly less mortality. When PC was not involved, BMT [OR 1.16; 95%CI 1.00-1.35] was associated with significantly higher and chemotherapy [OR 0.85; 95%CI 0.73-0.98] with significantly lower mortality.

Conclusion

In addition to symptom management and advance care planning, PC involvement in admitted MM patients with an infection might be associated with lower mortality. Longitudinal studies need to be conducted to establish a causal relationship of this hypothesis. Separate ICD10 codes for PC and hospice would result in a more accurate assessment of PC involvement in patient care.

No relevant conflicts of interest to declare.