Researchers at the 2024 ASCO Annual Meeting investigated hospital outcomes among patients with multiple myeloma (MM) admitted with gastrointestinal (GI) bleeding.
GI bleeding in patients with MM can arise due to a myriad of factors, including abnormal protein deposition in the GI tract, coagulation abnormalities, or secondary conditions such as amyloidosis.
“There’s limited scientific evidence examining outcomes among patients presenting with both GIB and MM,” wrote Fayaz Khan, MD, and Kenan Rahima, MD, both affiliated with TriHealth in Cincinnati, Ohio. “Thus, our objective was to assess clinical outcomes in this specific population.”
The researchers analyzed data from the National Inpatient Sample spanning 2017 to 2020. They identified adult patients with MM hospitalized for GI bleeding. The study’s primary endpoint was inpatient mortality, with secondary endpoints including length of stay (LOS) and total hospital charges. The researchers conducted multivariable logistic regression analysis to estimate clinical outcomes.
Of 4,067,364 total hospitalizations for GI bleeding, 22,000 patients (5.9%) had concurrent MM. Several demographic differences emerged between MM and non-MM cohorts: the mean age was 71.9 versus 67.8 years, with men constituting 58% versus 52.2% of each respective cohort and White ethnicity accounting for 55.6% versus 66.1% of patients.
The cohort with MM exhibited distinct comorbidity profiles, including higher rates of atrial fibrillation (27.7% vs 25.6%), heart failure (30.7% vs 26.4%), acute kidney injury (45.6% vs. 29.4%), and chronic kidney disease (51.9% vs 28.6%). However, the researchers noted that the MM cohort had a comparatively lower prevalence of obesity (10.6% vs 14.5%), diabetes mellitus (32.1% vs 33.8%), chronic obstructive pulmonary disease (16.9% vs 20.4%), dyslipidemia (38.5% vs 40.7%), hypertension (22.9% vs 34.7%), anemia (26.3% vs 27.7%), and peripheral vascular disease (2.9% vs 4.1%).
Disparities in Outcomes Discovered
There were significant disparities in clinical outcomes between the two cohorts. The MM cohort had an in-hospital mortality rate of 10.9% compared with 6.3% in the non-MM cohort (OR, 1.5; 95% CI, 1.4-1.7). LOS was notably longer for the MM cohort at 9.6 days versus 6.7 days (IRR, 1.26; 95% CI, 1.21-1.32). Hospital charges also were substantially higher—patients with MM were charged $30,006 compared with $20,172 for those without MM (IRR, 1.34; 95% CI, 1.26-1.42).
The researchers noted that they adjusted their findings for various factors, including age, sex, race, comorbidities, and inflation over the study period. All the data demonstrated P-values less than 0.001.
The investigators summarized that patients with MM hospitalized for GI bleeding are generally older, predominantly men, and less frequently White. These patients tended to have higher rates of atrial fibrillation, heart failure, acute kidney injury, and chronic kidney disease but lower rates of other common comorbidities. This cohort experiences significantly worse clinical outcomes, including higher mortality, prolonged hospital stays, and greater resource utilization.
Given their findings, Drs. Khan and Rahima advocated for patients with MM to receive “prompt medical attention [and] appropriate management of bleeding.” They added that “addressing the underlying causes is crucial in improving outcomes and reducing mortality rates.”
“Treatment strategies often involve a multidisciplinary approach involving oncologists, hematologists, gastroenterologists, and other specialists to provide comprehensive care tailored to the individual’s condition,” the researchers concluded.
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