Impact of protein-calorie malnutrition and sarcopenia on mortality and other in-hospital outcomes on patients admitted with cirrhosis—a nationwide inpatient sample (NIS) assessment
Adham E. Obeidat, Ahmad A. Yassine, Michael GavinAbstract
Introduction:
Malnutrition and sarcopenia represent important complications of cirrhosis, arising from complex and multifactorial pathophysiological mechanisms. In this study, we evaluate the impact of malnutrition and sarcopenia on in-hospital mortality and other clinical outcomes among patients with cirrhosis.
Methods:
We used the Nationwide Inpatient Sample to identify adult hospitalizations for cirrhosis with concomitant malnutrition and sarcopenia using ICD-10 codes. The primary outcome was in-hospital mortality. Secondary outcomes included hepatic encephalopathy (HE), ascites, variceal bleed, sepsis, respiratory failure (RF), acute kidney injury (AKI), hepatorenal syndrome (HRS), and length of stay (LOS). Multivariable logistic regression was used to adjust for confounders.
Results:
An estimated 212,067 patients were admitted with cirrhosis during the study period, of whom 25,331 had concomitant malnutrition and sarcopenia. After adjustment for covariates, malnutrition and sarcopenia were associated with increased in-hospital mortality. Older age and White race were also predictors of higher mortality. In addition, malnourished cirrhotic patients demonstrated higher risks of sepsis, AKI, RF, HE, ascites, HRS, and prolonged LOS, but a lower likelihood of variceal bleeding.
Conclusion:
Cirrhotic patients with malnutrition and sarcopenia demonstrated higher in-hospital mortality and complications, contributing to prolonged LOS and greater health care burden. Clinicians should recognize malnutrition in this population and adopt a multidisciplinary management approach to improve outcomes.