Immunodeficiencies Push Readmissions in Malignant Tumor Patients: A Retrospective Cohort Study Based on the Nationwide Readmission Database

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2023 Jan 8

PMID 36612087

Authors

Wenchen Wang

Qingyu Meng

Yiping Cheng

Yalin Han

Yonggan Xue

Yanshen Kuang

Xuning Wang

Bobin Ning

Mu Ke

Zhipeng Teng

Sen Li

Peng Li

Hongyi Liu

Xiude Fan

Baoqing Jia

Affiliations

Soon will be listed here.

Abstract

Background: Immunodeficiency diseases (IDDs) are associated with an increased proportion of cancer-related morbidity. However, the relationship between IDDs and malignancy readmissions has not been well described. Understanding this relationship could help us to develop a more reasonable discharge plan in the special tumor population.

Methods: Using the Nationwide Readmissions Database, we established a retrospective cohort study that included patients with the 16 most common malignancies, and we defined two groups: non-immunodeficiency diseases (NOIDDs) and IDDs.

Results: To identify whether the presence or absence of IDDs was associated with readmission, we identified 603,831 patients with malignancies at their time of readmission in which 0.8% had IDDs and in which readmission occurred in 47.3%. Compared with NOIDDs, patients with IDDs had a higher risk of 30-day (hazard ratio (HR) of 1.32; 95% CI of 1.25-1.40), 90-day (HR of 1.27; 95% CI of 1.21-1.34) and 180-day readmission (HR of 1.28; 95% CI of 1.22-1.35). More than one third (37.9%) of patients with IDDs had readmissions that occurred within 30 days and most (82.4%) of them were UPRs. An IDD was an independent risk factor for readmission in patients with colorectal cancer (HR of 1.32; 95% CI of 1.01-1.72), lung cancer (HR of 1.23; 95% CI of 1.02-1.48), non-Hodgkin's lymphoma (NHL) (HR of 1.16; 95% CI of 1.04-1.28), prostate cancer (HR of 1.45; 95% CI of 1.07-1.96) or stomach cancer (HR of 2.34; 95% CI of 1.33-4.14). Anemia (44.2%), bacterial infections (28.6%) and pneumonia (13.9%) were the 30-day UPR causes in these populations. (4) Conclusions: IDDs were independently associated with higher readmission risks for some malignant tumors. Strategies should be considered to prevent the causes of readmission as a post discharge plan.

References

Cunningham-Rundles C . Common variable immune deficiency: case studies. Blood. 2019; 134(21):1787-1795. PMC: 6872959. DOI: 10.1182/blood.2019002062. View

Yarchoan R, Uldrick T . HIV-Associated Cancers and Related Diseases. N Engl J Med. 2018; 378(11):1029-1041. PMC: 6890231. DOI: 10.1056/NEJMra1615896. View

Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, van Sighem A . Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015; 15(7):810-8. PMC: 4528076. DOI: 10.1016/S1473-3099(15)00056-0. View

Chan T, Wolchok J, Snyder A . Genetic Basis for Clinical Response to CTLA-4 Blockade in Melanoma. N Engl J Med. 2015; 373(20):1984. DOI: 10.1056/NEJMc1508163. View

Cunningham-Rundles C, Bodian C . Common variable immunodeficiency: clinical and immunological features of 248 patients. Clin Immunol. 1999; 92(1):34-48. DOI: 10.1006/clim.1999.4725. View

Sun J, Shen L, Shah M, Enzinger P, Adenis A, Doi T . Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): a randomised, placebo-controlled, phase 3 study. Lancet. 2021; 398(10302):759-771. DOI: 10.1016/S0140-6736(21)01234-4. View

Ludwig H, Van Belle S, Barrett-Lee P, Birgegard G, Bokemeyer C, Gascon P . The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer. 2004; 40(15):2293-306. DOI: 10.1016/j.ejca.2004.06.019. View

Nipp R, Horick N, Qian C, Knight H, Kaslow-Zieve E, Azoba C . Effect of a Symptom Monitoring Intervention for Patients Hospitalized With Advanced Cancer: A Randomized Clinical Trial. JAMA Oncol. 2022; 8(4):571-578. PMC: 8832303. DOI: 10.1001/jamaoncol.2021.7643. View

Volberding P, Levine A, Dieterich D, Mildvan D, Mitsuyasu R, Saag M . Anemia in HIV infection: clinical impact and evidence-based management strategies. Clin Infect Dis. 2004; 38(10):1454-63. DOI: 10.1086/383031. View

10.

Hernandez-Ramirez R, Shiels M, Dubrow R, Engels E . Cancer risk in HIV-infected people in the USA from 1996 to 2012: a population-based, registry-linkage study. Lancet HIV. 2017; 4(11):e495-e504. PMC: 5669995. DOI: 10.1016/S2352-3018(17)30125-X. View

11.

Lang F, Schrors B, Lower M, Tureci O, Sahin U . Identification of neoantigens for individualized therapeutic cancer vaccines. Nat Rev Drug Discov. 2022; 21(4):261-282. PMC: 7612664. DOI: 10.1038/s41573-021-00387-y. View

12.

Stratton M, Campbell P, Futreal P . The cancer genome. Nature. 2009; 458(7239):719-24. PMC: 2821689. DOI: 10.1038/nature07943. View

13.

Fischl M, Galpin J, Levine J, Groopman J, Henry D, Kennedy P . Recombinant human erythropoietin for patients with AIDS treated with zidovudine. N Engl J Med. 1990; 322(21):1488-93. DOI: 10.1056/NEJM199005243222103. View

14.

Martinez-Jimenez F, Muinos F, Sentis I, Deu-Pons J, Reyes-Salazar I, Arnedo-Pac C . A compendium of mutational cancer driver genes. Nat Rev Cancer. 2020; 20(10):555-572. DOI: 10.1038/s41568-020-0290-x. View

15.

Kinlen L, Webster A, Bird A, Haile R, Peto J, Soothill J . Prospective study of cancer in patients with hypogammaglobulinaemia. Lancet. 1985; 1(8423):263-6. DOI: 10.1016/s0140-6736(85)91037-2. View

16.

Agarwal S, Mayer L . Diagnosis and treatment of gastrointestinal disorders in patients with primary immunodeficiency. Clin Gastroenterol Hepatol. 2013; 11(9):1050-63. PMC: 3800204. DOI: 10.1016/j.cgh.2013.02.024. View

17.

Weiss G, Ganz T, Goodnough L . Anemia of inflammation. Blood. 2018; 133(1):40-50. PMC: 6536698. DOI: 10.1182/blood-2018-06-856500. View

18.

Eades-Perner A, Gathmann B, Knerr V, Guzman D, Veit D, Kindle G . The European internet-based patient and research database for primary immunodeficiencies: results 2004-06. Clin Exp Immunol. 2007; 147(2):306-12. PMC: 1810463. DOI: 10.1111/j.1365-2249.2006.03292.x. View

19.

Tangye S, Al-Herz W, Bousfiha A, Chatila T, Cunningham-Rundles C, Etzioni A . Human Inborn Errors of Immunity: 2019 Update on the Classification from the International Union of Immunological Societies Expert Committee. J Clin Immunol. 2020; 40(1):24-64. PMC: 7082301. DOI: 10.1007/s10875-019-00737-x. View

20.

Ueckermann V, Janse van Rensburg L, Pannell N, Ehlers M . Characteristics and outcomes of patients admitted to a tertiary academic hospital in Pretoria with HIV and severe pneumonia: a retrospective cohort study. BMC Infect Dis. 2022; 22(1):548. PMC: 9202192. DOI: 10.1186/s12879-022-07522-z. View