Protein Energy Malnutrition and in-Hospital Outcomes Among Hospitalized Patients with Immune Thrombocytopenia: A United States Collaborative Network Cohort Study

Background

Immune thrombocytopenia (ITP) is an acquired form of thrombocytopenia seen in adults and children. It is characterized by immune-mediated platelet destruction and can lead to life-threatening bleeding in certain patients. Protein-energy malnutrition (PEM) can lead to adverse outcomes in many medical conditions; however, whether its presence leads to adverse outcomes in patients with ITP is yet to be determined.

Methodology

We conducted a secondary analysis of data from the United States Collaborative Network-TriNetX. Our study sample included patients with ITP [defined based on the International Classification of Disease, 10th Revision (ICD-10) code (D69.3)]. PEM was our primary exposure (determined based on the ICD-10 code E46). ITP patients with and without PEM were propensity-matched to ensure both groups had similar sociodemographic characteristics. Clinical outcomes assessed were hospital readmission, intensive care unit (ICU) admission, recurrent bleeding, need for transfusion, risk of myocardial infarction (MI) and pulmonary embolism (PE), and all-cause mortality. Generalized linear models were used to measure the association of PEM and the clinical outcomes of interest. Estimates were presented as risk ratios and 95% confidence intervals, and a p-value of <0.05 was considered statistically significant.

Results

After propensity score matching, 4607 participants were included in each cohort. In the PEM cohort, 46% were male, 64%% were white, and the mean age was 64.8 years (SD +/- 20.2). About 76% had hospital readmission, 30% had an ICU admission, 13% experienced recurrent bleeding, 15% needed transfusion, 6% had MI and PE, and all-cause mortality was 32% in the PEM cohort. Participants admitted with ITP and concurrent PEM had a statistically significant higher risk of hospital readmission (RR 1.329, 95% CI: 1.290-1.369), ICU admission (RR 2.153, 95% CI: 1.980-2.341), recurrent bleeding (RR 1.145, 95% CI: 1.026-1.278), need for transfusion (RR 1.640, 95% CI 1.423-1.889), risk of MI and PE (RR 1.507, 95% CI 1.226-1.852), and risk of all-cause mortality (RR 1.905, 95% CI 1.764-2.056) when compared to those without PEM.

Conclusion

Our study found a considerable proportion of patients with ITP and comorbid PEM. Findings suggest that ITP patients with concurrent PEM are at a higher risk of adverse health outcomes and mortality than ITP patients without PEM. Early recognition and prompt management of PEM among patients with ITP may contribute to improved clinical outcomes.