Clinical Outcome Of Hospitalized Patients Undergoing Left Ventricular Assist Device Implantation With Comorbid Protein-energy Malnutrition: A Study Utilizing The Nationwide Inpatient Sample (NIS) Database

Abstract

Background

Patients with advanced heart failure are often at risk of malnutrition, which correlates with poor long-term outcomes such as increased heart failure hospitalizations, overall mortality, and heightened risk of complications. However, the impact of protein-energy malnutrition (PEM) on patients that specifically hospitalized for left ventricular assist device (LVAD) implantation remains unclear. Thus, our study aims to investigate this relationship.

Methods

We analyzed the 2020 U.S. National Inpatient Sample (NIS) to investigate the impact of concurrent diagnosis of PEM on the hospital outcome of patients admitted for LVAD implantation. Participants aged above 18 years were included using relevant ICD-10 CM codes. Multivariable logistic and linear regression analyses were employed to calculate adjusted odds ratios (aORs) for specific in-hospital outcomes.

Results

Among 3,645 patients admitted for LVAD implantation, the mean age was 56±13 years, with 25.3% female. Ethnicities comprised Caucasians (55%), Blacks (32%), Mexican Americans (6%), Asians (2%), and others (4%). Of these, 34.6% (1,270/3,645) had concurrent PEM diagnosis. Overall, the in-hospital mortality rate was 10.9%. In a multivariable regression model adjusting for patient and hospital factors, patients with PEM had a prolonged stay (45 days vs. 34 days, Beta_LOS 9.9, 95% CI 5.4 to 14.4, p < 0.001) and had a 1.57-fold higher risk of mechanical ventilation use than those without PEM (aOR 1.57, 95% CI 1.03 to 2.41, p = 0.038). However, there was no statistically significant increase in the risk of in-hospital mortality (aOR 1.96, 95%CI 0.59 to 1.93, p = 0.835), acute kidney injury (aOR 1.42, 95% CI 0.91 to 2.20, p = 0.121), post-procedural bleeding (aOR 1.28, 95% CI 0.85 to 1.92, p = 0.243), or renal replacement therapy utilization (aOR 1.33, 95% CI 0.68 to 2.61, p = 0.405).

Conclusion

Our findings indicate that concurrent PEM is associated with longer hospital stays and an increased risk of requiring mechanical ventilation. Future longitudinal cohort studies are needed to understand these connections better.