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Burden of Influenza-Related Hospitalizations and Attributable Mortality in Pediatric Acute Lymphoblastic Leukemia
Grace E Lee1, Brian T Fisher2, Rui Xiao3
1Division of Infectious Diseases Department of Pediatrics.
Insights
Influenza hospitalizations are common and deadly in children with acute lymphoblastic leukemia (ALL). This study highlights the significant burden of influenza in pediatric cancer patients, emphasizing increased mortality and resource use.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Epidemiology
Background:
- Influenza poses a severe risk to patients with malignancy.
- The impact of influenza hospitalizations and mortality in pediatric cancer patients remains largely unknown.
Purpose of the Study:
- To determine the rate of influenza hospitalizations and attributable mortality in children with acute lymphoblastic leukemia (ALL).
Main Methods:
- Retrospective cohort study of 10,698 children with new-onset ALL from 41 US children's hospitals (1999-2011).
- Influenza hospitalizations identified via ICD-9 codes; follow-up censored at key events.
- Calculated hospitalization rates and crude attributable in-hospital mortality.
Main Results:
- The influenza hospitalization rate was 618.3 per 100,000 person-months.
- Attributable in-hospital mortality was 1.0%, highest in infants and children <2 years old.
- Influenza hospitalizations led to significantly longer stays, more antibiotic use, and increased intensive care.
Conclusions:
- Influenza represents a substantial burden for children with ALL.
- Influenza is associated with increased resource utilization and mortality in this vulnerable pediatric population.
Background:
Influenza can be severe in patients with underlying malignancy; however, the rate of influenza hospitalizations and attributable mortality in children with cancer is unknown.
Methods:
We performed a retrospective cohort study among 10 698 children with new-onset acute lymphoblastic leukemia (ALL) from 41 US children's hospitals between January 1999 and September 2011. Influenza-related hospitalizations were identified using ICD-9 discharge diagnosis codes, excluding hospitalizations during low-prevalence influenza periods. Follow-up was censored at the earliest of 5 events: end of study period, expected end of chemotherapy, last known hospitalization, hematopoietic stem cell transplant, or death. Data were collected on hospitalization characteristics and resource utilization. Hospitalization rates were calculated using season-adjusted person-time. Crude attributable in-hospital mortality was calculated using baseline mortality for noninfluenza hospitalizations during the same period. Subgroup analysis was performed by time from ALL diagnosis and by age category.
Results:
The rate of influenza-related hospitalizations was 618.3 per 100 000 person-months. Rates were similar by time from ALL diagnosis and across age categories. Overall attributable in-hospital mortality was 1.0% (95% confidence interval [CI], 0.3%-2.3%) and was highest for children <6 months from diagnosis (1.6%; 95% CI, 0.4%-4.5%) and children <2 years of age (6.7%; 95% CI, 1.3%-22.7%). Total length of stay, days of broad-spectrum antibiotic exposure, and duration of intensive care were significantly greater for influenza-related hospitalizations compared with noninfluenza hospitalizations.
Conclusions:
The burden of influenza-related hospitalizations in children with ALL is high and associated with significantly increased resource utilization and attributable mortality.
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