Impact of Protein Energy Malnutrition on Hospitalized Patients with Chronic Myeloid Leukemia: A United States Population-Based Cohort Study

Background

Advances in chemotherapeutics and newer TKIs (tyrosine kinase inhibitors) have increased survival in patients with chronic myeloid leukemia (CML). With prolonged survival, these patients are often predisposed to comorbidities affecting their quality of life. Patients with CML suffer from varying degrees of protein-energy malnutrition (PEM) due to multiple factors, including cachexia, sarcopenia, and adverse effects of chemotherapeutics. However, the impact of PEM on outcomes among patients with CML needs further exploration.

Methods

We used the 2020 National Inpatient Sample (NIS) Database to conduct this retrospective cohort study. We identified patients with CML and PEM using appropriate ICD-10 diagnostic codes. We stratified patients with CML 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. This study aimed to investigate the impact of PEM on in-hospital mortality, hospital length of stay (LOS), and total hospitalization charges among hospitalized patients with CML.

Results

We identified a total of 3845 hospitalized patients with CML, of which 10.14% (390/3845) had comorbid PEM. The overall in-hospital mortality among patients with CML was 6.38% (245/3845). Among those with concomitant PEM, the mortality rate was significantly higher at 14.10% (55/390, p=0.003). 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 2.72; 95% (confidence interval [CI] 1.27-5.83; p=0.010), longer LOS (coefficient 11.58; CI 6.60-16.56; p=0.001), higher total hospitalization charges ($247587; CI $53783-$441391; p=0.012), and increased need for mechanical ventilation (adjusted OR 4.71; CI 1.68-13.15; p=0.003).

Conclusion

Our analysis demonstrated that PEM was widely prevalent in hospitalized patients with CML. It was associated with significantly worsened in-hospital mortality, longer LOS, total cost of healthcare utilization, and increased need for mechanical ventilation. Efforts should be made to promote nutritional assessment and screening mechanisms to include early nutritional support as indicated. Further prospective studies with larger sample sizes are warranted to understand these associations better.

No relevant conflicts of interest to declare.