Protein energy malnutrition is associated with worse clinical outcomes in asthma hospitalization: A nationwide analysis

Introduction

Several studies have highlighted the negative clinical impact of malnutrition in individuals with various disease conditions, including diseases related to the respiratory system. Our study sought to investigate the relationship between protein-energy malnutrition and asthma exacerbation.

Methods

We retrospectively searched the National Inpatient Sample (NIS) from 2018 to 2021. We searched the NIS for adult patients hospitalized with asthma exacerbation (AE) as the principal diagnosis and protein energy malnutrition (PEM) as a secondary diagnosis using ICD-10 codes. The primary outcome measures were inpatient mortality, while the secondary outcomes were length of stay (LOS), odds of respiratory failure (RF), cardiac arrest, pneumothorax, need for invasive mechanical ventilation, need for ECMO and health cost utilization, defined by total hospitalization costs. Multivariate logistic and Poisson regression analyses were applied to estimate the correlations.

Results

A total of 325,510 patients were admitted for AE, 2,965 (0.91 %) of whom had underlying PEM. The PEM cohort had increased odds of mortality (aOR 3.70, p < 0.001). Similarly, the PEM cohort had increased odds of cardiac arrest (aOR 2.45, p = 0.008), pneumothorax (aOR 4.94, p < 0.001), acute respiratory failure (aOR 2.07, p = 0.001), and need for invasive mechanical ventilation (aOR 3.52, p < 0.001). The study group had a significant increase in length of stay (adjusted mean difference 3.67, p = 0.0001) and charge of care (adjusted mean difference 52,819 $, p < 0.0001).

Conclusions

Our study indicated that protein-energy malnutrition is associated with increased mortality and adverse clinical outcomes during hospitalization for asthma. PEMs also contributed to increased healthcare resource utilization.