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Early Unplanned Readmissions and Mortality After Induction Chemotherapy in AML
Journal article   Peer reviewed

Early Unplanned Readmissions and Mortality After Induction Chemotherapy in AML

Sena Chae, Alaa Harb, Grerk Sutamtewagul, Yelena Perkhounkova, Marisa Mueterthies, Faith Hendricks, Maria Hein and Tamara G R Macieira
JCO clinical cancer informatics, Vol.10(3), e2600018
07/2026
DOI: 10.1200/CCI-26-00018
PMID: 42585617

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Abstract

AML is a highly aggressive hematologic cancer. During induction chemotherapy, up to 40% of patients experience complications resulting in unplanned readmissions or early death. This study aimed to identify the reasons for postinduction unplanned readmissions and to develop predictive models for unplanned readmissions or early death using structured and unstructured electronic health record (EHR) data to identify patients at highest risk. We retrospectively analyzed 1,111 inpatient encounters from 305 adult patients with AML treated at a Midwestern university hospital between 2006 and 2021. Inclusion criterion was adults with AML undergoing induction chemotherapy; exclusion criteria included acute promyelocytic leukemia, stem cell transplant recipients, and confirmed chronic myeloid leukemia. Adverse events-unplanned readmissions or mortality within 30 days of discharge from the initial induction hospitalization-were identified through chart review using predefined rules. Multiple logistic regression was used to identify risk factors. Variable selection was performed using the least absolute shrinkage and selection operator. Within 30 days postdischarge, 22% of patients experienced an unplanned readmission. The most frequent reasons were fever/infection (53.5%), metabolic/GI/renal complications (16.2%), and pain/discomfort (14.1%). Mortality within 30 days was 22%. Predictive performance improved when comorbidities and symptom frequency from clinical notes were added (AUC increased from 0.67 to 0.74). Statistically significant predictors of increased adverse event risk included solid neoplasm (odds ratio [OR], 2.34), higher cardiopulmonary symptom burden per day (OR, 1.16), and a chemotherapy intensity moderated by age (OR, 0.90). Unplanned readmissions or early mortality occurred in 39.7% of patients with AML within 30 days postdischarge. Integrated risk stratification tools leveraging structured and unstructured EHR data may inform timely interventions to improve survival and reduce avoidable hospitalizations.
 Adult Aged Female Humans Induction Chemotherapy - adverse effects Induction Chemotherapy - methods Induction Chemotherapy - mortality Leukemia, Myeloid, Acute - drug therapy Leukemia, Myeloid, Acute - mortality Male Middle Aged Patient Readmission - statistics & numerical data Retrospective Studies Risk Factors

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