Impact of COVID-19 infection on hospitalization outcomes in patients with myeloproliferative neoplasms: Analysis of the national inpatient sample 2020–2021

Abstract INTRODUCTION: Myeloproliferative neoplasms (MPN) are a group of clonal hematopoietic stem cell disorders characterized by overproduction of one or more of myeloid lineages. MPNs are associated with an increased inflammatory and prothrombotic state. We hypothesize that MPN in conjunction with COVID-19 infection is associated with worse outcomes.METHODOLOGY: We queried the National Inpatient Sample database (2020-2021) to include individuals ≥ 18 years of age with MPN using International Classification of Diseases-10 diagnosis codes. The cohort was subcategorized based on the presence of COVID-19 infection. Hospital length of stay (LOS), total hospitalization charges and in-hospital mortality were the primary outcomes. Secondary outcome were various individual organ system failure.RESULTS: A total of 37,650 hospitalizations with MPN were identified. Of this, 460 (1.2%) had concurrent COVID-19 infection. Patients with COVID-19 had a mean age of 69.2 versus 66.5 years without COVID-19. There was no difference in sex distribution in the groups. MPN with COVID-19 group was more likely to be insured under Medicare (72.4% vs. 64.9%, P=0.01). 52.1% of the patients with MPN and COVID-19 had a Charlson Comorbidity Index (CCI) of ≥ 3 indicative of a high comorbidity burden.Patients hospitalized with COVID-19 and MPN had significantly higher odds of mortality (aOR: 2.65 CI: 1.65–4.26, p value <0.001) with a length of stay >5 days (aOR: 2.12 CI: 1.45–3.11, p value <0.001). The total hospitalization cost with concomitant COVID-19 infection were $38,942 (95% CI: $7,820–70,064, P value 0.01). After adjusting for demographic characteristics and cardiovascular risk factors, COVID-19 group remained at an elevated risk of acute kidney injury (aOR 2.98, 95% CI 2.10–4.22), acute respiratory failure (aOR 2.33, 95% CI 1.44–3.78) and severe sepsis (aOR 2.19, 95% CI 1.22–3.94). Incidence of myocardial infarction was 7.2% in the COVID-positive group versus 3.6% in those without the infection (P=0.001). Similarly, incidence of ischemic stroke was 5.4% versus 2.9% (P=0.004), incidence of pulmonary embolism (PE) 6.5% versus 3.4% (P=0.001), and deep vein thrombosis (DVT) in 8% vs. 4.9% (P<0.001).DISCUSSION: Patients with MPN and concomitant COVID-19 infection had prolonged and costlier hospital stays with higher odds of inpatient mortality. Notably, thromboembolic events such as myocardial infarction, stroke, PE and DVT showed nearly double the incidence in COVID-19 group suggesting that COVID infection possibly potentiates the existing prothrombotic and hyperinflammatory state in patients with MPN. This calls for increased vigilance and monitoring in this vulnerable subgroup of patients. Additionally, early and aggressive thromboembolic prophylaxis maybe an appropriate consideration in the right clinical context. Nonetheless, more prospective studies are required to establish such an association.