Outcomes of Patients Hospitalized with Neutropenic Fever and COVID-19 Infection: A Nationwide Analysis

Abstract

Abstract Importance: Neutropenic fever (NF) is an oncological emergency associated with worse outcomes. Unfortunately, there is a paucity of existing literature describing the association between neutropenic fever and COVID-19 infection. Objective: This study investigates the effect of COVID-19 infection on outcomes of hospitalization with neutropenic fever, highlighting the patients’ characteristics. Design: Retrospective cohort analyses were conducted using the National Inpatient Sample database year 2020. Setting: Population-basedinpatient database in the United States Participants: All neutropenic fever adult hospitalizations (16,790 patients) were identified from the database using ICD-10 codes and were stratified into with and without COVID-19 infection. Main Outcomes and Measures: The primary outcome of interest was inpatient mortality. Secondary outcomes include respiratory failure, hemorrhagic shock, septic shock, acute kidney injury (AKI), health economic burden defined as longer length of stay (LOS), higher hospital cost, and patient charge. Results: The database query generated 16,790 adult patients with a primary diagnosis of neutropenic fever. Of these, 145 patients had concurrent neutropenic fever and COVID-19 infection. Patients with neutropenic fever and COVID-19 infection had 14 times higher odds (adjusted odds ratio (AOR) = 13.6, 95% confidence interval (CI) = 3.6 – 51.8) of inpatient mortality when compared to those without COVID-19. Additionally, they had 21 times greater odds of septic shock [10.3% vs. 0.4%, aOR/aIRR = 20.8, 95% CI 4.5 – 96.5], and 11 times higher odds of respiratory failure [27.6% vs. 4.0%, aOR/aIRR = 10.6, 95% CI 4.1 – 27.5] when compared to their counterparts without COVID-19. Furthermore, these patients had longer hospital stay (9.1 vs. 5.1 days, aIRR 1.14, 95% CI 1.3–2.4), higher average hospital cost ($20,279 vs. $15,357, aIRR 1.3, 95% CI 1.1–1.7), and higher average patient charges ($96,300 vs. $57,338, aIRR 1.7, 95% CI 1.1 – 2.7) Conclusion and Relevance: Neutropenic fever with concurrent COVID-19 infection was associated with significantly higher in-hospital mortality, greater risk of septic shock, respiratory failure, longer average hospital stay, and higher average hospital cost. Further research is needed to explore interventions to improve outcomes in hospitalized neutropenic fever patients with COVID-19. Prevention of COVID-19 infection in this population is expedient.