Factors Associated with in-Hospital Mortality in Patients with Burkitt Lymphoma - Analysis of the National Inpatient Sample (NIS)

Introduction

Burkitt Lymphoma (BL) is a highly aggressive B-cell non-Hodgkin Lymphoma, characterized by translocation and dysregulation of the MYC gene. BL comes in three distinct forms: endemic, sporadic, and immunodeficiency-related. BL has become a highly curable disease after the development of intense chemo-immunotherapy regimens, but given the low incidence of the disease, nationally representative studies on outcomes are scarce. We aim to highlight the most recent population-based factors associated with inpatient mortality and morbidity in patients with Burkitt's lymphoma.

Methods

The National Inpatient Sample database was queried from October 2015 to December 2020.

Adults aged >= 18 with a primary diagnosis of BL were identified and stratified into those with and without the outcome of mortality. Complications included were queried using ICD codes most commonly found in the secondary diagnosis variables. Baseline characteristics, inpatient complications, and outcomes were compared using chi-squared and Wilcoxon rank-sum tests. Logistic regression analysis was performed to assess the risk of death before and after adjusting for multiple risk factors.

Results

We found 3,650 admissions with a primary diagnosis of BL, of which 320 (8.8%) patients died during the hospitalization. Patients who died had higher Charlson Comorbidity Index (CCI) >=3 (69%), tumor lysis syndrome (TLS) (41%), Sepsis (39%), and acute hypoxic respiratory failure (AHRF) (33%). No significant differences were found according to income, hospital bed-size or geographical region. In univariable analysis patients who died tended to be older with age >= 65 years (OR 2.55 (1.23 to 5.26) p=0.039), however, once adjusting for other variables there was no significant difference in mortality by age group, race, or gender. Multivariable analysis identified 3 factors with high association with mortality: acute renal failure (OR 3.07 (1.63 to 5.76), p<0.001), sepsis (OR 7.96 (3.85 to 16.4), p<0.001), and acute hypoxic respiratory failure (OR 2.70 (1.23 to 5.92), p=0.013).

Conclusion

BL remains a highly aggressive but potentially curable disease in patients able to tolerate intensive chemo-immunotherapy regimens. Our study highlights multiple factors that are independently associated with death include acute renal failure, sepsis, and acute hypoxic respiratory failure. Close monitoring should be placed on patients with the above complications to improve survival.