Impact of Acute Renal Failure on Clinical Outcomes in Bone Marrow Transplant Patients: A Nationwide Analysis

Introduction:

Acute renal failure (ARF) complicates bone marrow transplant (BMT) procedures and significantly affects clinical outcomes. This study examines the impact of ARF on mortality, resource use, and other key outcomes in a nationwide cohort of BMT patients.

Methods:

Data were extracted from the National Inpatient Sample (NIS) database, which includes BMT hospitalizations from 2016 to 2021. Patients were classified into two groups: those with ARF (BMT+ ARF+) and those without ARF (BMT+ ARF-). The analysis compared demographic characteristics, baseline health conditions, and clinical outcomes between these groups. Multivariate logistic regression was employed to analyze outcomes adjusting for potential confounders.

Results:

Among the 139,085 BMT hospitalizations, 32,205 patients were identified with ARF. Patients with ARF were older, with a mean age of 55.58 years compared to 46.49 years for those without ARF. Gender distribution differed between groups, with a higher proportion of males in the ARF group (60.47% vs. 55.30%). Racial composition also varied; ARF patients had a larger proportion of White individuals (69.01% vs. 66.41%) and a smaller proportion of Hispanic individuals (10.93% vs. 13.61%) compared to the non-ARF group.

ARF patients had an odds ratio (OR) of 5.42 for mortality (95% CI 4.77-6.16, p < 0.001). The likelihood of requiring transfusions was increased with an OR of 1.61 (95% CI 1.48-1.75, p < 0.001). Additionally, ARF patients had higher odds of bleeding (OR = 1.63, 95% CI 1.48-1.79, p < 0.001), sepsis (OR = 2.92, 95% CI 2.73-3.13, p < 0.001), and septic shock (OR = 6.97, 95% CI 6.22-7.80, p < 0.001). The odds of myocardial infarction were also elevated (OR = 1.64, 95% CI 1.38-1.93, p < 0.001), while arrhythmia had an OR of 1.32 (95% CI 1.07-1.63, p = 0.01). The risk of BMT infection and BMT failure was higher with ORs of 2.16 (95% CI 1.14-4.08, p = 0.017) and 1.39 (95% CI 1.09-1.79, p = 0.008), respectively. Although the odds of BMT rejection were not significantly different (OR = 1.22, 95% CI 0.77-1.94, p = 0.39). ARF patients also experienced longer hospital stays (mean 11.53 days vs. 6.79 days) and incurred higher total healthcare charges ($202,288 vs. $99,901).

Conclusion:

ARF is associated with worse clinical outcomes in BMT patients, with increased mortality, extended hospital stays, and higher healthcare costs. The study also highlights notable differences in gender and racial composition between ARF and non-ARF patients, suggesting that demographic factors may influence the impact of ARF. These findings underscore the need for tailored management strategies to address ARF effectively and to reduce disparities in care. Further research is necessary to refine these strategies and optimize care for this high-risk population.

No relevant conflicts of interest to declare.