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Open Access Publications from the University of California

Early mortality and complications in hospitalized adult Californians with acute myeloid leukaemia

  • Author(s): Ho, G
  • Jonas, BA
  • Li, Q
  • Brunson, A
  • Wun, T
  • Keegan, THM
  • et al.

Published Web Location Commons Attribution-NonCommercial-NoDerivatives 4.0 International Public License

© 2017 John Wiley & Sons Ltd Few studies have evaluated the impact of complications, sociodemographic and clinical factors on early mortality (death ≤60 days from diagnosis) in acute myeloid leukaemia (AML) patients. Using data from the California Cancer Registry linked to hospital discharge records from 1999 to 2012, we identified patients aged ≥15 years with AML who received inpatient treatment (N = 6359). Multivariate logistic regression analyses were used to assess the association of complications with early mortality, adjusting for sociodemographic factors, comorbidities and hospital type. Early mortality decreased over time (25·3%, 1999–2000; 16·8%, 2011–2012) across all age groups, but was higher in older patients (6·9%, 15–39, 11·4%, 40–54, 18·6% 55–65, and 35·8%, >65 years). Major bleeding [Odds ratio (OR) 1·5, 95% confidence interval (CI) 1·3–1·9], liver failure (OR 1·9, 95% CI 1·1–3·1), renal failure (OR 2·4, 95% CI 2·0–2·9), respiratory failure (OR 7·6, 95% CI 6·2–9·3) and cardiac arrest (OR 15·8, 95% CI 8·7–28·6) were associated with early mortality. Higher early mortality was also associated with single marital status, low neighbourhood socioeconomic status, lack of health insurance and comorbidities. Treatment at National Cancer Institute-designated cancer centres was associated with lower early mortality (OR 0·5, 95% CI 0·4–0·6). In conclusion, organ dysfunction, hospital type and sociodemographic factors impact early mortality. Further studies should investigate how differences in healthcare delivery affect early mortality.

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