PREVALENCE AND IMPACT OF PROTEIN-CALORIE MALNUTRITION IN PATIENTS HOSPITALIZED WITH GASTROINTESTINAL DISORDERS

Introduction
Protein-calorie malnutrition (PCM) has been reported in up to 48% of hospitalizations and is associated with adverse clinical outcomes, such as increased length of stay, morbidity, and mortality. PCM is known to be intricately linked with IBD and infections, but the relationship between PCM and various gastrointestinal (GI) disorders is less well defined. The aim of this study was to evaluate the prevalence and impact of PCM in patients hospitalized with different GI conditions.

Methods
The National Inpatient Sample was queried for patients hospitalized with and without GI disorders between 2016 and 2018. GI disorders were identified based on ICD-10 codes in the first 3 diagnosis positions. The prevalence of PCM was compared across patients with different GI disorders and patients without a GI disorder. Multivariable logistic and linear regression were performed to compare death, length of stay and total utilization charges between those with and without PCM, adjusting for age, sex, race, comorbidity index, elective admission, primary payer, zip code income, residence population size, region, hospital size, hospital urban and teaching status.

Results
Amongst 107,001,354 hospitalization events from 2016-2018, there were 8,246,820 (7.7%) patients hospitalized with a GI condition. The prevalence of PCM was highest in those with esophageal dysmotility, Clostridioides difficile infection, cholangitis, infectious gastroenteritis, Crohn’s disease, ulcerative colitis, GI bleed, gastroparesis, chronic pancreatitis, and acute pancreatitis, and had higher prevalence of PCM compared to all combined non-GI disorders (Table 1). Patients with PCM hospitalized for a GI disorder had greater adjusted relative odds of death (OR: 3.09; 95% CI: 2.96-3.22), longer length of stay (4.31; 95% CI 4.21-4.40), and higher total charges (38788.14; 95% CI: 37303.79-40272.49) compared to those without PCM (Table 2).

Conclusion
Our study found increased utilization metrics amongst all patients hospitalized for a GI disorder with PCM, with increased relative mortality, length of stay, and total charges. GI disorders that impact motility and ability to tolerate oral intake, such as esophageal motility and gastroparesis, had increased PCM prevalence. Inflammatory disorders, including all infection types, IBD and pancreatitis also had rates of PCM greater than those hospitalized without a GI disorder, potentially due to increased catabolism and poor nutrition in these states. Our findings highlight the importance of early recognition and treatment of PCM in these specific GI conditions given the increased utilization burden seen in these patients.