Psychological Risk Factors on Hematopoietic Stem Cell Transplantation Patients: Insights From National Readmission Database Analysis.
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BACKGROUND: Psychosocial risk factors (PSRFs) have emerged as important nontraditional risk factors for poor medical outcomes but have not been well-studied in the field of hematopoietic stem cell transplantation (HSCT). OBJECTIVES: In this study, we retrospectively examined in-hospital and short-term outcomes in patients with PSRFs who underwent HSCT. METHODS: We used the National Readmission Database (NRD) to identify patients who underwent HSCT between 2011 and 2020. Patients were stratified based on the presence of either 0 or ≥ 1 PSRFs, which included factors such as mental illness, substance abuse, cognitive problems, a low income level, and an uninsured status. Patients were also classified into allogeneic-HSCT (allo-HSCT) and autologous-HSCT (auto-HSCT) groups. Our primary endpoints were in-hospital and short-term outcomes. RESULTS: In this nationally representative cohort, 90,747 patients underwent auto-HSCT, while 26,600 patients underwent allo-HSCT. In the auto-HSCT group, individuals with PSRFs exhibited notably higher in-hospital mortality (2.4% vs. 2.8%; p < 0.001) and 30-day all-cause readmission rates (14.4% vs. 17.8%; p < 0.001) compared to those without PSRFs. Similarly, within the allo-HSCT group, patients with PSRFs had significantly higher in-hospital mortality (5.4% vs. 6.4%; p < 0.001) and 30-day all-cause readmission rates (27.3% vs. 31.2%; p < 0.001) compared to those without PSRFs. After adjusting for risk factors, the presence of PSRFs emerged as a substantial predictor for heightened 30-day readmission in allo-HSCT and auto-HSCT. CONCLUSION: The presence of PSRFs is correlated with poorer in-hospital and short-term outcomes after both allo-HSCT and auto-HSCT, with a more pronounced effect observed in allo-HSCT. This research underscores the significance of pinpointing high-risk patients and implies support for merging PSRFs after HSCT is beneficial.