Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency resulting from rapid destruction of malignant cells and subsequent metabolic derangements.

TLS is associated with acute kidney injury, electrolyte abnormalities, cardiac arrhythmias, and multiorgan dysfunction.

Although the clinical manifestations of TLS are well established, contemporary national estimates evaluating its association with inpatient outcomes remain limited.

We evaluated the impact of TLS on mortality, organ failure, and healthcare utilization among hospitalized patients with hematologic malignancies.

• Study Design: Retrospective cohort study using the 2022 National Inpatient Sample (NIS).

• Study Population: Adult hospitalizations with hematologic malignancies identified using ICD-10-CM diagnosis codes.

• Exposure: Tumor lysis syndrome identified using ICD-10-CM code E88.3 in any diagnosis position.

• Primary Outcome: In-hospital mortality

• Secondary Outcomes: Acute dialysis requirement, Mechanical ventilation, Length of stay (LOS)

• Covariates: Multivariable models adjusted for Age, Sex, Race/ethnicity, Chronic kidney disease, Diabetes mellitus, Heart failure, Coronary artery disease, Hypertension, COPD, Obesity, & Liver disease

  • Approximately 19.97 million weighted hospitalizations involving hematologic malignancies.

  • 2,300 unweighted admissions with TLS.

  • TLS independently increased inpatient mortality.

  • TLS significantly increased dialysis utilization and mechanical ventilation.

  • Hospitalization was prolonged by nearly 8 additional days.

    • TLS was associated with markedly increased inpatient mortality after adjustment for demographics and comorbidity burden.

    • TLS substantially increased the likelihood of acute dialysis and mechanical ventilation, reflecting severe systemic illness.

    • Hospitalizations complicated by TLS were associated with significantly prolonged length of stay.

    • Sensitivity analyses restricting TLS to secondary diagnosis positions demonstrated similar findings, supporting the robustness of the results.

    • Strengths include the use of a nationally representative database and multivariable adjustment.

    • Limitations include reliance on administrative coding and lack of laboratory data, disease stage, or treatment information.

    
    
    
    

    • TLS remains one of the most serious complications among hospitalized patients with hematologic malignancies.

    • Early recognition, aggressive prophylaxis, and prompt management are critical to reducing mortality and organ failure.

    • These findings support heightened inpatient surveillance and standardized TLS prevention strategies for high-risk patients.