TY - JOUR
T1 - Impact of Malnutrition in Patients With Infective Endocarditis
AU - Harris, Ché Matthew
AU - Albaeni, Aiham
AU - Norris, Keith C.
N1 - Funding Information:
Financial disclosure: This research was supported by a grant from the National Heart, Lung, and Blood Institute to the University of Mississippi Medical Center (1R25HL126145‐01—MPIs Beech and Norris). K. C. Norris is also supported by NIH grants UL1TR000124 and P30AG021684.
Funding Information:
We included patients with a principal diagnosis of IE and excluded patients with a BMI ?25 kg/m2 (if they were in the malnutrition arm, as obesity has also been considered a state of malnutrition in some cases) or under 18 years of age. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify eligible admissions with a principle diagnosis of IE and secondary diagnosis of malnutrition based on previous literature7 (see Supplementary Table). Of note, because ?feeding difficulties and mismanagement? was found to be a risk factor for in-hospital mortality8 and also included under malnutrition in the HCUP statistical brief (https://www.ncbi.nlm.nih.gov/books/NBK410088/table/sb218.t5/), we added this diagnostic code to the malnutrition variable as well (see Supplementary Table). We used 2014 data from the National Inpatient Sample (NIS) database from the Agency for Healthcare Research and Quality generated by the Healthcare Cost and Utilization Project (HCUP).6 The NIS is the largest national all-payer inpatient care database designed as a stratified probability sample, representing nonfederal acute care inpatient hospitalizations in North America.
Publisher Copyright:
© 2020 American Society for Parenteral and Enteral Nutrition
PY - 2021/4
Y1 - 2021/4
N2 - Background: Effects of malnutrition on patients with infective endocarditis (IE) have not been fully studied. Because malnutrition is associated with poor health, we hypothesized that among patients with IE, those with malnutrition would have more negative in-hospital outcomes. Methods: The National Inpatient Sample was used to identify adults ≥18 years old with IE. We compared outcomes of in-hospital mortality, morbidity, valvular interventions, and utilization of resources between individuals with and without malnutrition. Results: 11,939 adults ≥18 years were hospitalized with IE, 2035 had a secondary diagnosis for malnutrition. There were no significant differences in age (mean age ± SEM: 55.6 ± 1.0 vs 54.3 ± 0.4 years, P =.21) or sex (female: 36.7%; 743/2,035 vs 37.5%; 3,717/9,904, P =.69) in patients with and without malnutrition. Patients with malnutrition had more comorbidities (Charlson comorbidity score ≥3: 36%; 732/2,035 vs 30.7%; 3,040/9,904, P =.04). Despite similar adjusted in-hospital mortality (adjusted odds ratio [aOR], 1.4; 95% CI, 0.8–1.5; P =.23), malnourished patients were more likely to develop sepsis (aOR, 1.7; 95% CI, 1.2–2.4; P <.01) and had higher odds of mitral-valve (aOR, 1.7; 95% CI, 1.2–2.4; P <.01) repairs/replacements. Patients with malnutrition also had increased lengths of stay (adjusted mean difference [aMD], 4.7 days; 95% CI, 2.9–6.5 days; P <.01) and hospital charges (aMD, $36,052; 95% CI, $14,935–$57,168; P <.01). Conclusions: Patients with malnutrition and IE are at risk for high morbidity, valvular repairs/replacements, and use of hospital resources.
AB - Background: Effects of malnutrition on patients with infective endocarditis (IE) have not been fully studied. Because malnutrition is associated with poor health, we hypothesized that among patients with IE, those with malnutrition would have more negative in-hospital outcomes. Methods: The National Inpatient Sample was used to identify adults ≥18 years old with IE. We compared outcomes of in-hospital mortality, morbidity, valvular interventions, and utilization of resources between individuals with and without malnutrition. Results: 11,939 adults ≥18 years were hospitalized with IE, 2035 had a secondary diagnosis for malnutrition. There were no significant differences in age (mean age ± SEM: 55.6 ± 1.0 vs 54.3 ± 0.4 years, P =.21) or sex (female: 36.7%; 743/2,035 vs 37.5%; 3,717/9,904, P =.69) in patients with and without malnutrition. Patients with malnutrition had more comorbidities (Charlson comorbidity score ≥3: 36%; 732/2,035 vs 30.7%; 3,040/9,904, P =.04). Despite similar adjusted in-hospital mortality (adjusted odds ratio [aOR], 1.4; 95% CI, 0.8–1.5; P =.23), malnourished patients were more likely to develop sepsis (aOR, 1.7; 95% CI, 1.2–2.4; P <.01) and had higher odds of mitral-valve (aOR, 1.7; 95% CI, 1.2–2.4; P <.01) repairs/replacements. Patients with malnutrition also had increased lengths of stay (adjusted mean difference [aMD], 4.7 days; 95% CI, 2.9–6.5 days; P <.01) and hospital charges (aMD, $36,052; 95% CI, $14,935–$57,168; P <.01). Conclusions: Patients with malnutrition and IE are at risk for high morbidity, valvular repairs/replacements, and use of hospital resources.
KW - endocarditis
KW - infections
KW - length of stay
KW - malnutrition
KW - mortality
KW - outcomes
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U2 - 10.1002/ncp.10557
DO - 10.1002/ncp.10557
M3 - Article
C2 - 32700334
AN - SCOPUS:85088320195
VL - 36
SP - 472
EP - 479
JO - Nutrition in Clinical Practice
JF - Nutrition in Clinical Practice
SN - 0884-5336
IS - 2
ER -