INTRODUCTION

Patients with chronic lymphocytic leukemia (CLL) are particularly vulnerable to severe infections due to disease-related immune dysfunction, treatment-associated immunosuppression, and advanced age.

Sepsis remains an important cause of morbidity and mortality in this population.

The impact of COVID-19 co-infection on contemporary sepsis outcomes in patients with CLL remains important to characterize. 

METHOD

Data source: National Inpatient Sample, 2020-2022

Population: Adults with CLL admitted with a principal diagnosis of sepsis, identified using ICD-10-CM codes

Primary outcome: Inpatient mortality

Secondary outcomes: Length of stay, hospital charges, acute kidney injury (AKI), mechanical ventilation, vasopressor use, and atrial fibrillation

Analysis: Weighted national estimates and multivariable logistic regression adjusting for demographics, insurance, neighborhood income, hospital characteristics, comorbidity burden, and COVID-19 co-infection

RESULTS

Mortality remained persistently high

2020: 15.9%

2021: 17.9%

2022: 15.6%

No significant improvement over time (p=0.853)

COVID-19 co-infection increased substantially

2020: 13.5%

2022: 24.5%

Independent predictors of inpatient mortality

Mechanical ventilation: OR 12.53 (95% CI 10.49–14.95)

COVID-19 co-infection: OR 2.40 (95% CI 2.03–2.84)

Vasopressor use: OR 2.18 (95% CI 1.46–3.25)

Acute kidney injury: OR 2.16 (95% CI 1.86–2.52)

Older age: OR 1.03 per year (95% CI 1.02–1.04)

Higher neighborhood income was associated with lower mortality: OR 0.74 (95% CI 0.59-0.92)

Despite declining rates of mechanical ventilation and AKI, overall mortality did not improve from 2020-2022.