Impact of the Cardiorenal-Pulmonary Triad on Inpatient Outcomes in Diffuse Large B-Cell Lymphoma: A National Inpatient Sample Analysis (2016-2020)

Diffuse large B-cell lymphoma (DLBCL) is the most prevalent aggressive form of non-Hodgkin lymphoma, which is often treated in an inpatient environment due to increased prevalence of acute organ failure, infection, and treatment-related toxicity. Previous inpatient analyses have demonstrated that cardiovascular comorbidities in DLBCL are linked to worse hospital outcomes; however, these studies have mostly examined single-condition effects rather than a multiorgan acute phenotype.   

Acute kidney damage (AKI), acute heart failure (HF), and acute respiratory failure (ARF) are all linked to poorer outcomes, but their combined impact on hospitalized patients with DLBCL has not been thoroughly studied nationally. Because these patients may need early multidisciplinary co-management and higher-intensity inpatient monitoring, it is therapeutically significant to understand this cardiorenal-pulmonary overlap.

We assessed whether the co-occurrence of AKI, acute HF, and ARF is linked to higher in-hospital mortality, longer hospital stays, and higher hospitalization costs among adult admissions with DLBCL using the National Inpatient Sample (NIS) 2016-2020.

This is a retrospective, National Inpatient Sample study using inpatient hospital admissions from  2016 to 2020. The study was conducted using the ICD-10 coding system.  Statistical analysis was performed using STATA version 19.  

A six-level cardiorenal-pulmonary triad variable was created by combining exposures to acute kidney injury (AKI), acute heart failure (HF), and acute respiratory failure (ARF): none, AKI only, HF only, ARF only, any two, and all three. Three major outcomes were high total charges ( >75th percentile), extended length of stay (LOS) ( >75th percentile), and in-hospital mortality.

Among 72,832 DLBCL admissions identified from 34,955,252 all-cause NIS hospitalizations from 2016-2020, 75.36% had no triad component, 13.55% had AKI only, 1.40% had acute HF only, 4.01% had ARF only, 4.92% had any two components, and 0.76% had all three. Increasing triad burden was associated with older age, greater comorbidity, longer LOS, and higher charges. Unadjusted in-hospital mortality increased from 1.16% in the no-triad group to 34.95% in those with any two components and 29.06% in those with all three; similarly, LOS more than the 75th percentile rose from 17.26% to 66.97%, and total charge more than the 75th percentile rose from 19.47% to 59.85% between no triad vs all three triad component respectively. 

In adjusted models, compared with no triad component, mortality odds were higher for AKI only (aOR 4.82, 95% CI 4.27-5.45), acute HF only (aOR 1.62, 95% CI 1.08-2.42), ARF only (aOR 18.88, 95% CI 16.50-21.59), any two components (aOR 33.80, 95% CI 29.49-38.74), and all three components (aOR 22.70, 95% CI 17.93-28.74). Triad level was also strongly associated with prolonged LOS and high charges (both p < 0.001), with significant interaction by chemotherapy-admission status.

Among hospitalized adults with DLBCL, AKI, acute HF, and ARF show graded and clinically relevant associations with in-hospital mortality, prolonged LOS, and high hospitalization charges. Integrating this triad into inpatient risk stratification may improve care intensity matching, early resource planning, and the selection of eligible patients for appropriate treatment modalities.