OBJECTIVES:

To compare trends in hospital length of stay, total costs and comorbidities in patients with Acute, Chronic and ‘Acute on Chronic’ Graft-Versus Host Disease (GVHD).

METHODS: The 2016 National Inpatient Sample (NIS) data set was utilized in order to determine the number of hospital admissions for Acute, Chronic and ‘Acute on Chronic’ GVHD. Propensity score matched analysis was conducted to compare hospital LOS, costs and mortality in selected patients. Thirty comorbidities were assessed using Elixhauser scoring. Multivariate logistic regression was conducted to assess predictor variables for LOS and costs.

RESULTS:

In 2016, there were an estimated 3000, 6225 and 845 hospitalizations with a diagnosis of acute, chronic and acute on chronic GVHD, respectively. The mean age was similar across all three groups (44.84 [SD 21.07], 48.11 [SD 18.82] and 44.12 [SD 20.55] years) and 61%, 59% and 56% were male, in acute, chronic and acute on chronic GVHD, respectively. The hospital LOS was significantly higher in the acute and acute on chronic groups as compared to the chronic GVHD group (24.7 [SD 27.87] and 17.17 [SD 22.75] versus 9.87 [SD 16.38] days, respectively). Similarly, the mean hospital charges were significantly higher in the acute and acute on chronic groups as compared to the chronic GVHD group ($421,956 $280,820 versus $136,977, respectively). The percentage of patients who died in the hospital was also significantly high in the acute and acute on chronic groups as compared to the chronic GVHD group (14.67%, 14.79% vs 7.08%, respectively). The most common comorbidities across the three groups were: Coagulopathy, Renal Failure, Weight Loss, Depression and Hypertension.

CONCLUSIONS: Patients with GVHD have long hospital length of stay, high total charges and high rate of mortality. There is an urgent need for new treatment approaches to improve clinical and economic outcomes for patients with GVHD.