Abstract 18257: Arrhythmias in Tumor Lysis Syndrome

Background: Tumor lysis syndrome (TLS) is a common complication seen among hospitalized patients with acute promyelocytic leukemia (APL) undergoing induction therapy. Question: What is the incidence and type of arrhythmias in patients with TLS? Methods: This study utilized the National Inpatient Sample Database between 2015-2019 to identify patients hospitalized with APL and further subclassify them into those with and without TLS. ICD-10 codes were used to identify different types of arrhythmias in both groups. A multivariate logistic regression model was constructed to assess adjusted odds ratio for all-cause mortality and cardiac/renal complications. Results: A total of 9938 hospitalizations with APL were identified. Of those, 415 patients had TLS (4.2%). APL patients with TLS were older and more likely to be males. CVA, CHF, CAD, HTN and higher comorbidity scores were more frequent among patients with TLS (Table 1). On adjusted analysis, Patients with TLS had ~2.7-fold increase in all-cause mortality (aOR 2.74, 95% CI [2.12 - 3.55], p< 0.01). In addition, TLS patients had higher rates of cardiac arrhythmias (33.7% vs 21.4%, p<0.01). Atrial fibrillation was the most common arrhythmia (45%), followed by ventricular arrhythmias (11.3%), and lastly, torsade de pointes (8.2%). Finally, TLS patients were more likely to have AKI (aOR 4.13, 95% [3.31 - 5.16], and need hemodialysis (aOR 3.44, 95% CI [2.34 - 5.05], p<0.01). Conclusion: Patients with TLS are at high risk for arrhythmias, all-cause mortality and cardiac morbidity. Preventive strategies like continuous telemetry monitoring may allow for early identification of arrhythmias and may help improve outcomes.