Impact of Protein Energy Malnutrition on Hospitalized Patients with Hodgkin’s Lymphoma: A United States Population-Based Cohort Study

Background

Advances in chemotherapeutics have increased survival in patients with Hodgkin’s lymphoma. With prolonged survival, these patients are often predisposed to co-morbidities, including cancer-related cachexia, muscle wasting, and adverse effects of chemotherapy. As a result, these patients suffer from varying degrees of protein-energy malnutrition (PEM). However, the impact of PEM on outcomes among patients with Hodgkin’s lymphoma needs further exploration.

Methods

We utilized the 2020 National Inpatient Sample (NIS) Database to conduct this retrospective cohort study. We identified patients with Hodgkin’s lymphoma and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with Hodgkin’s lymphoma based on the presence or absence of PEM. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p-value of <0.05 was considered statistically significant. The aim of this study was to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charges among hospitalized patients with Hodgkin’s lymphoma.

Results

We identified a total of 3705 hospitalized patients with Hodgkin’s lymphoma, of which 13.36% (495/3705) had comorbid PEM. The overall in-hospital mortality among patients with Hodgkin’s lymphoma was 2.97% (110/3705). Among those with concomitant PEM, the mortality rate was significantly higher at 9.09% (45/495, p<0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, PEM was found to be an independent predictor of increased in-hospital mortality (adjusted OR 3.71; 95% (confidence interval [CI] 1.23-11.21; p=0.02), longer LOS (coefficient 2.88; CI 0.49-5.28; p=0.018), higher total hospitalization charges ($41649; CI $4818-$78481; p=0.027), as well as increased need for mechanical ventilation (adjusted OR 4.28; CI 1.50-12.18; p=0.006).

Conclusion

Our analysis demonstrated that PEM was widely prevalent in patients with Hodgkin’s lymphoma. It was associated with worse outcomes, including significantly increased in-hospital mortality, longer LOS, total cost of healthcare utilization, as well as increased need for mechanical ventilation. Efforts should be made to promote nutritional assessment and screening mechanisms to include early nutritional support as indicated. Prospective studies with larger sample size are needed to better understand these associations.