Chemotherapy-induced agranulocytosis plus AF tied to poor clinical outcomes
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Concomitant chemotherapy-induced agranulocytosis and atrial fibrillation was associated with increased in-hospital mortality, hospital stay and health care cost among patients with cancer, a speaker reported.
According to a presentation at the American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient virtual course, the presence of AF in chemotherapy-induced agranulocytosis was also tied to greater risk for major adverse CV events and septic shock compared with chemotherapy-induced agranulocytosis and no AF.
“Chemotherapy-induced agranulocytosis is very common after we initiate chemotherapy in cancer patients,” Chengyue Jin, MD, internal medicine resident at Westchester Medical Center and New York Medical College, said during the presentation. “This group of patients tends to be older, and atrial fibrillation is common in older patient populations as well. ... However, there is no prior study showing the coexistence of those conditions and their clinical implications.”
For the present analysis, researchers collected data from the National Inpatient Sample database to identify patients who experienced chemotherapy-induced agranulocytosis in 2016. The primary outcome was in-hospital mortality. The secondary outcomes were major adverse CV events, septic shock and health care resource utilization such as cost and length of stay.
Analyses were conducted among patient subgroups, including those with solid cancers, liquid cancers and liquid tumor subtypes, including diffuse large B-cell lymphoma, lymphoblastic lymphoma, peripheral T-cell lymphoma, anaplastic large cell lymphoma, mediastinal large B-cell lymphoma, plasma cell leukemia, acute myeloblastic leukemia and more.
Among patients with chemotherapy-induced agranulocytosis and AF, there was greater risk for in-hospital mortality (OR = 2.48; 95% CI, 1.9-3.23; P < .001), major adverse CV events (OR = 2.08; 95% CI, 1.46-2.96; P < .001) and septic shock (OR = 3.31; 95% CI, 2.56-4.27; P < .001) compared with those without AF, Jin and colleagues found.
Moreover, concomitant chemotherapy-induced agranulocytosis and AF was associated with longer hospital stay (coefficient, 2.07 days; 95% CI, 1.4-2.74; P < .001) and higher cost (coefficient, $7,890.55; 95% CI, 5,415.45-10,365.65; P < .001) compared with chemotherapy-induced agranulocytosis and no AF.
Outcomes were similar between patients with solid or liquid tumors.
In the subgroup analysis of patients with more aggressive liquid tumor subtypes, researchers observed that AF was not associated with longer hospital stay (coefficient, 1.97 days; 95% CI, –0.28 to 4.22; P = .086) nor major adverse CV events (OR = 2.46; 95% CI, 0.66-9.17; P = .18); however, AF was still associated with increased in-hospital mortality (OR = 4.53; 95% CI, 1.6-12.86; P = .004), septic shock (OR = 6.58; 95% CI, 2.7-16.02; P < .001) and higher cost (coefficient, $13,255.86; 95% CI, 1,972.62-24,539.1; P = .021).
“Atrial fibrillation associated with worse clinical outcomes and tends to utilize more resources during hospitalization in patients with chemotherapy-induced agranulocytosis. Unfortunately, due to the retrospective nature of our study and also the database we used, which was a claim-based database, we couldn’t further elucidate the association between atrial fibrillation and worse clinical outcomes in this group of patients,” Jin said. “Further prospective, if possible, randomized control trials, are warranted.”
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Jin C. Original Research Abstract 57. Presented at: American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient virtual course; Feb. 11-12, 2022 (virtual meeting).
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