Impact of Malnutrition on Patients with Sickle Cell Anemia Hospitalized with Vaso-Occlusive Crisis: A US Collaborative Network Cohort Study

Background

Malnutrition is frequently seen in patients with sickle cell anemia (SCA). It is associated with a weakened immune system and reduced pain threshold, increasing the risk of vaso-occlusive pain crises (VOC). However, its impact on the clinical outcomes of patients hospitalized for vaso-occlusive crises remains unclear. Therefore, we conducted a national-level cohort study to elucidate these outcomes.

Methods

We used data from the US Collaborative Network-TriNetX to evaluate the impact of malnutrition on patients with SCA who were hospitalized for VOC. Patients were divided into two cohorts: those with malnutrition, identified by the relevant ICD-10 codes, and those without. The malnutrition cohort was propensity score matched with a control group based on age, sex, gender, and various comorbidities. They were followed for 30 days post-hospitalization to assess outcomes such as mortality, need for transfusion, splenic infarction, stroke, myocardial infarction, acute kidney injury, and readmission.

Results

After propensity score matching, each cohort consisted of 1,517 patients with similar baseline characteristics. The mean age for both cohorts was 32 years, with the malnutrition cohort being 51% female and the non-malnutrition cohort 53% female. The ethnic distribution was 67% Black, 12% White, and the remainder of unknown ethnicity. Our analysis found that within 30 days post-hospitalization, the cohort with malnutrition had a significantly higher risk of mortality (RR: 3.05, 95% CI: 1.93-4.81, P<0.001), need for blood transfusion (RR: 2.17, 95% CI: 1.68-2.81, P<0.001), ischemic stroke (RR: 1.98, 95% CI: 1.07-3.69, P<0.001), and myocardial infarction (RR: 1.97, 95% CI: 1.12-3.46, P<0.001). There was also an increased risk of acute kidney injury (RR: 2.57, 95% CI: 1.94-3.41, P<0.001) and readmission (RR: 2.34, 95% CI: 2.00-2.74, P<0.001). There was no significant difference in the occurrence of acute chest syndrome or splenic infarction.

Conclusion

Our study reveals that malnutrition in patients with SCA hospitalized for VOC is significantly associated with a heightened risk of adverse outcomes, including increased mortality, ischemic stroke, myocardial infarction, and acute kidney injury. A multidisciplinary approach to managing malnutrition in sickle cell anemia is essential to improving survival and outcomes in these patients.