Clinical outcome and prognostication of patients with inflammatory and immune myopathies with and without chemotherapy in the United States.
Baljinder Singh1, Yixin Chen2, Xueying Liu2, Harmandeep Singh Brar3, Rajeev Motiwala1, Simrandeep Brar4, Jacqueline Kraus5, Elina Zakin1
1NYU School of Medicine, 2Virginia Tech University, 3Shri Guru Ram Das Medical College India, 4Texas Tech University Health Sciences center, 5University of New Mexico
Objective:

To compare the clinical outcome and in-hospital complication risk with chemotherapy and without chemotherapy in patients with inflammatory and immune myopathies. 

Background:
Inflammatory and immune myopathy (IIM) is an umbrella term that comprises various types of myopathies based on the result of autoantibodies and clinical presentation. Very limited data is available on patients who were diagnosed with IIM and required chemotherapy for underlying malignancies. 
Design/Methods:

We obtained data for IIM patients admitted to hospitals in the United States from 2017 to 2019 with a primary diagnosis of IIM using a large national database. We determined the rate and pattern of utilization of associated in-hospital outcomes of chemotherapy in this patient population. 

 

Results:

A total of 1072 patients had IIM out of which 63 (5.8%) received chemotherapy for the underlying malignancies. No racial differences were observed in both groups, however mean age for the patients who required chemotherapy was more than the non-chemotherapy group (72.7±11 vs 67.5±15, p <0.01). Patients who received chemotherapy had more in-hospital complications including, sepsis (25.1% vs. 11.6%, p<0.01), and acute kidney injury (23.8%% vs. 13.2%, p < 0.01). No significant difference was noticed in the length of stay during hospitalization in both groups. The number of deaths were higher in the chemotherapy group. In a further study of patients who died in the chemotherapy group, the risk of myocardial infarction (MI) was 16 times higher in comparison to the alive patients (p<0.01)

 

Conclusions:
In hospitalization complications such as sepsis and acute kidney injury were higher in the patients who received chemotherapy in IIM patients and patients who died had 16 times more risk of having MI. This study highlights the need of strict sepsis prevention protocols in this patient population. Further research is required to study the cardiac cause of death in these patients.
10.1212/WNL.0000000000205385