142 - Upper Gastrointestinal Bleeding Among Children With Acute Lymphoblastic Leukemia; Did the Outcomes Differ Between Males and Females?

Publication Number: 2136.142

Shruti Aggarwal, The Brooklyn Hospital Center, Brooklyn, NY, United States; Rahul Arora, Central Michigan University College of Medicine, SAGINAW, MI, United States; Sayera Muqarram, Central Michigan University College of Medicine, SAGINAW, MI, United States; Rigved V. Jeurkar, BJ Government Medical College, Pune, Pune, Maharashtra, India; Rahul Singla, Guru Gobind Singh Medical College, Bathinda, Punjab, India; Kamleshun Ramphul, Independent Researcher, Triolet, Pamplemousses, Mauritius; Noah P. Kondamudi, The Brooklyn, Brooklyn, NY, United States

Background: Recent reports from the American Cancer Society confirm that leukemia remains the leading cause of cancer among the pediatric population. While upper gastrointestinal bleeding (UGIB) is a known complication in children with Acute Lymphoblastic Leukemia (ALL), there is a lack of recent studies comparing clinical characteristics and outcomes between male and female patients. This retrospective study utilized a nationally representative sample to enhance our understanding.

Objective: Compare in-hospital mortality between male and female patients. Assess differences in complications, interventions, hospital stay, and charges.

Design/Methods: We focused on children under 18 years of age with ALL (not in remission) who were admitted with UGIB from 2016 to 2021. Data were extracted from the National Inpatient Sample and divided by sex. Differences between groups were analyzed. Adjusted odds ratios (aOR) for all-cause mortality were calculated using multivariable logistic regression.

Results: A total of 655 pediatric ALL cases with UGIB were identified: 390 (59.5%) males and 265 (40.5%) females. Male patients were older, with a mean age of 10.82 years compared to 7.98 years for females (p < 0.01). There were no significant sex-based differences in rates of sepsis (males: 21.8%, females: 24.5%, p=0.414), septic shock (males: 15.4%, females: 15.1%, p=0.919), acute kidney injury (males: 25.6%, females: 20.8%, p=0.149), use of mechanical ventilation (males: 23.1%, females: 17.0%, p=0.058), or need for esophagogastroduodenoscopy (EGD) (males: 12.8%, females: 13.2%, p=0.885). However, more males underwent blood transfusion (46.2%) compared to females (37.7%, p=0.033). Mortality was higher in males (19.5%, aOR 2.473, 95% CI 1.292–4.734, p< 0.01) than females (5.7%), and mean hospital charges were significantly greater in males ($1,048,041 vs. $727,100, p=0.011). Length of stay did not differ significantly (males: 35.12 days, females: 35.89 days, p=0.832).

Conclusion(s): Although rates of sepsis, organ dysfunction, and procedures such as EGD were similar between groups, male patients demonstrated higher transfusion needs, significantly greater mortality, and incurred substantially higher hospital charges. Notably, males were also older on average at presentation, suggesting age or disease severity may be contributing factors. These differences highlight a potential sex-based vulnerability in pediatric ALL patients with UGIB. Further prospective studies are needed to better understand these disparities and guide targeted interventions to improve outcomes in high-risk groups.