National trends and inpatient outcomes of invasive aspergillosis in hospitalizations with hematologic malignancies: A 2020-2022 National Inpatient Sample analysis.

Abstract

e18519 Background: Invasive aspergillosis is a severe opportunistic fungal infection affecting immunocompromised patients, particularly those with hematologic malignancies. We examined the inpatient burden and outcomes of invasive aspergillosis among U.S. hospitalizations involving hematologic malignancies. Methods: We performed a retrospective analysis of the 2020–2022 National Inpatient Sample, identifying hospitalizations with hematologic malignancies using ICD-10-CM codes C81–C96. Invasive aspergillosis was defined using ICD-10-CM codes B44.0, B44.1, B44.7, and B44.89; non-invasive forms were excluded. Survey-weighted analyses accounted for the complex sampling design. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay (LOS), total hospital charges, ICU-level care (mechanical ventilation and vasopressor use as proxies), and neutropenia. Multivariate regression adjusted for demographic, socioeconomic, comorbidity, and hospital-level factors. Results: Among approximately 1,789,899 U.S. adult hospitalizations with hematologic malignancies, an estimated 6,170 were complicated by aspergillosis (weighted prevalence 0.34%). Within the aspergillosis group, males predominated (63.5%), and patients younger than 65 years were more common (55.8%). White patients constituted the largest racial group (65.2%), followed by Hispanic (15.3%), Black (8.3%), and Asian patients (7.4%). Medicare was the most common primary payer (45.1%), most hospitalizations had a high comorbidity burden (Charlson score ≥3 in 68.2%), and higher ZIP-code income quartiles were more frequently represented. After multivariate adjustment, aspergillosis was independently associated with higher in-hospital mortality (OR 4.02, 95% CI 3.41–4.75), longer LOS (adjusted increase 12.4 days, 95% CI 10.94–13.78), and higher total hospital charges (adjusted increase $305,750, 95% CI $249,237–$362,264; all p < 0.05). Aspergillosis was also associated with increased illness severity, including higher odds of mechanical ventilation (OR 3.96), vasopressor use (OR 3.08), overall ICU-level care (OR 3.73), and neutropenia (OR 2.59; all p < 0.05). Conclusions: Invasive aspergillosis was an infrequent complication among hospitalizations with hematologic malignancies but was associated with severe inpatient illness and substantial healthcare utilization, highlighting the need for early prognostic awareness and individualized care planning.