Impact of blood transfusion on clinical outcomes in patients hospitalized with acute promyelocytic leukemia: A nationwide analysis

Abstract Background: Acute promyelocytic leukemia (APL) is a distinct and aggressive subtype of acute myeloid leukemia characterized by a high risk of coagulopathy and early death if not properly managed. Supportive care, particularly the use of blood products, plays a critical role in managing complications such as disseminated intravascular coagulation (DIC) and hemorrhage. However, the clinical impact of blood transfusions on outcomes among hospitalized APL patients remains incompletely characterized. This study evaluates the associations between blood products transfusion and in-hospital outcomes using a nationally representative inpatient dataset. Methods: Patients aged ≥18 years with a primary diagnosis of APL were identified using ICD-10-CM codes from the National Inpatient Sample (NIS) database between January 1, 2017, and December 31, 2022. Patients were stratified based on receipt of blood products (packed red blood cells) transfusion. Demographic and clinical characteristics were compared between transfused and non-transfused groups. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included complications such as sepsis, DIC, organ failure, hospital length of stay (LOS), and total hospitalization costs. Multivariable logistic and Poisson regression models adjusted for potential confounders were used to assess associations. Statistical significance was set at p<0.05. Results: A total of 7,354 adult APL hospitalizations were included, of whom 2,290 (31.1%) received blood transfusions. Transfused patients were younger (mean age: 50.7 vs. 53.2 years; p=0.0107) and more likely to be Hispanic (19.0% vs. 13.8%; p=0.010), with a lower proportion of White patients (54.1% vs. 66.4%; p<0.001). The proportion of Black patients was higher in the transfused group (14.2% vs. 11.4%), though not statistically significant (p=0.14). No significant differences were observed in sex, income, comorbidity burden (Charlson Comorbidity Index), insurance type, or hospital characteristics. There was no statistically significant difference in all-cause in-hospital mortality between transfused and non-transfused groups (adjusted odds ratio [aOR] 1.07; 95% CI 0.73–1.57). However, transfused patients had significantly higher odds of developing sepsis (aOR 1.70; 95% CI 1.24–2.33) and DIC (aOR 1.59; 95% CI 1.25–2.01). They were also more likely to require mechanical ventilation (aOR 1.50; 95% CI 1.01–2.21) and vasopressor support (aOR 2.02; 95% CI 1.06–3.83). Patients who received blood transfusions had significantly longer hospital stays (mean LOS: 27.36 vs. 22.01 days; adjusted incidence rate ratio [aIRR] 1.18; 95% CI 1.09–1.28) and higher total hospitalization costs ($430,436 vs. $336,041; aIRR 1.19; 95% CI 1.07–1.35). No significant differences were observed in rates of acute kidney injury, acute coronary syndrome, ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, venous thromboembolism, or acute heart failure.Conclusion: Among patients hospitalized with acute promyelocytic leukemia, blood transfusion was not associated with increased in-hospital mortality but was linked to greater rates of critical complications such as sepsis and DIC, increased need for intensive care interventions, and substantially higher resource utilization. These findings underscore the importance of optimizing transfusion practices and monitoring in this high-risk population.