Hospital-acquired sepsis as a driver of failure-to-rescue in AML and MDS: A national inpatient sample analysis, 2016–2023.

e23219 Background: Sepsis is a frequent proximate cause of inpatient death in acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS), yet national data quantifying a hospital-acquired sepsis–linked failure-to-rescue signal are limited. This study evaluated sepsis timing phenotypes and associated mortality, ICU-level escalation, and resource utilization in AML/MDS hospitalizations. Methods: A survey-weighted analysis of the National Inpatient Sample (2016–2023) was conducted. Adult hospitalizations with AML or MDS were identified from diagnosis coding; obstetric admissions were excluded. Sepsis was classified using a length-of-stay timing proxy as early/present-on-admission (≤2 days), late/hospital-acquired (≥4 days), or indeterminate (3 days; excluded from primary analyses). Outcomes included in-hospital mortality, ICU-level care (mechanical ventilation, dialysis/CRRT, or shock), length of stay, costs/charges, and discharge disposition. Survey-weighted regression models adjusted for demographics, payer, income quartile, admission characteristics, hospital factors, year, and hospital AML/MDS volume. Results: The weighted cohort included approximately 1.05 million AML/MDS hospitalizations from 2016–2023. Hospital-acquired sepsis occurred in 14.9% of admissions, compared with 2.2% with sepsis present on admission. In-hospital mortality differed markedly by sepsis timing: 18.3% for hospital-acquired sepsis, 42.4% for present-on-admission sepsis, and 4.3% for admissions without sepsis. Among hospital-acquired sepsis admissions, ICU-level careoccurred in 20.6%, invasive mechanical ventilation in 14.9%, and dialysis/CRRT in 6.8%. In adjusted analyses, hospital-acquired sepsis was independently associated with higher in-hospital mortality compared with no sepsis (adjusted odds ratio [aOR] 5.11, 95% CI 4.89–5.34). Present-on-admission sepsis demonstrated an even higher mortality association (aOR 16.95, 95% CI 15.78–18.20). Among hospital-acquired sepsis admissions, mortality increased with age (aOR 1.01/year, 95% CI 1.01–1.01) and male sex (female vs male aOR 0.87, 95% CI 0.81–0.93). Death was more likely in urban teaching hospitals (aOR 1.59, 95% CI 1.33–1.90) and large hospitals (aOR 1.51, 95% CI 1.36–1.68), with higher failure-to-rescue also observed in high-volume AML/MDS centers (aOR 1.25, 95% CI 1.14–1.38). Conclusions: In AML/MDS hospitalizations, late hospital-acquired sepsis is common and is associated with high failure-to-rescue, frequent ICU escalation, and markedly increased mortality and resource use. Sepsis timing emerges as a scalable inpatient vulnerability and quality signal in hematologic malignancies, highlighting the need for systems-level strategies to prevent late sepsis and improve rescue.