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Trends in pneumonia (PNA) hospitalization among patients (pts) with chronic lymphocytic leukemia (CLL).

e20500 Background: Despite recent therapeutic advances, PNA remains a significant source of morbidity and mortality among CLL pts. We determined population-level estimates for the incidence and outcome of PNA hospitalizations. We further investigated secular trends in care by comparing cohorts before (1994) and after (2004) the widespread use of multiagent chemoimmunotherapy.


METHODS
Using data from the U.S. Nationwide Inpatient Sample and ICD-9CM diagnosis codes, we identified all non-governmental hospitalizations of CLL pts for a primary dx of PNA in calendar years 1994 and 2004. Admissions were described by pt demographics (age, gender, race) and comorbidity (Charlson index, presence of chronic lung disease). Ten-year prevalence estimates for CLL were obtained from NCI SEER data and used as denominators in incidence calculations. Outcomes studied included need for intubation, in-hospital mortality, and length of stay (LOS). All analyses were sample weighted. Estimates and 95% confidence limits are reported.


RESULTS
PNA was the primary dx for 7316 (13.1%) and 7651 (11.2%) CLL pt admissions in 1994 and 2004, respectively. Incidence of PNA admission was similar in 1994 (140/per 1000 pts, 95%CI 130-151) and 2004 (129/per 1000 pts, 95%CI 119-138). CLL pts admitted in 2004 were older (75.7 v. 74.2 years, p<0.001) and more likely to have at least one Charlson comorbidity (67.6% v. 56.2%, p<0.001) or comorbid chronic lung disease (40.6% v. 28.3%, p<0.001) than pts in 1994. Intubation was rare in both cohorts (<1%) and did not significantly differ by year, but in-hospital mortality was significantly higher in 2004 (11.3% v. 8.2%, p=0.005). However, LOS decreased significantly between 1994 and 2004 (9.2 v. 6.4 days, p<0.001).


CONCLUSIONS
PNA hospitalization rates for CLL pts have not significantly increased over the last decade despite more aggressive therapies, likely secondary to improved supportive care. However, CLL pts hospitalized for PNA are now older, increasingly likely to suffer from chronic medical illness, and significantly more likely to die while in hospital. Therapuetic strategies targeting older pts with significant comorbidities are needed. No significant financial relationships to disclose.