Protein-Energy Malnutrition in Multiple Myeloma - Impact on the in-Hospital Outcomes and Thrombotic Events in Patients with Multiple Myeloma

Protein-Energy Malnutrition in Multiple Myeloma - Impact on The In-Hospital Outcomes and Thrombotic Events in Patients with Multiple Myeloma.

Introduction

Cancer is often associated with malnutrition, and this could be due to the disease or its treatment (PMID: 37783594, PMID: 24748626, PMID: PMID: 36276153). Thrombosis is common in multiple myeloma (MM) and is often attributed to the effect of treatment rather than the malignancy itself. (PMID: 22507814). There is a paucity of data on the effect of protein-energy malnutrition (PEM) on hospital outcomes in patients with MM. Our aim in this study was to assess the effect of PEM on the in-hospital outcomes in patients with MM.

Materials and Methods:

A retrospective cohort study was done using the National Inpatient Sample database from 2017 to 2020 extracting diagnoses and procedures utilizing the ICD 10-CM codes. Inclusion criteria were hospitalized patients over the age of 18 years with MM. PEM and its impact on outcomes in patients with MM were evaluated after stratifying the patients into two groups based on the presence or absence of PEM. A comparative analysis of population characteristics and outcomes was done between the treatment groups using the T-test for continuous variables and Pearson's chi-square test or logistic regression for categorical variables. Finally, we conducted a multivariate logistic regression for the primary outcome, adjusting for age, gender, race, and co-morbidities. The primary outcome was in-hospital mortality. Secondary outcomes were the length of stay (LOS), total hospital charges (THC), and the occurrence of thromboembolic events. Analysis was performed with STATA Basic Edition version 18.0. A p-value of < 0.05 was considered statistically significant.

Results:

We identified 15,706 patients with MM, of which 2,661 (16.94%) had PEM. On multivariable analysis, the presence of malnutrition was associated with increased odds of in-hospital mortality (adjusted odds ratio [aOR] 1.99, 95% confidence interval [CI] 1.61-2.46; P=0.00). Patients with malnutrition had an increased LOS (2.69 days, 95% CI 2.15-3.24; P=0.00), higher THC ($31,596.33, 95% CI 21925.49-41267.17; P=0.00), and increased odds of having concomitant DVT (aOR 1.31, 95% CI 1.05-1.64; P<0.02), PE (aOR 1.90, 95% CI 1.28-2.83; P<0.01), and acute MI (aOR 1.31, 95% CI 1.01-1.71; P<0.05). The presence of malnutrition was not associated with the development of CVA (aOR 0.83, 95% CI 0.48-1.46; P=0.52).

Conclusion

From our study, we identified a significant association between PEM and increased LOS, DVT, PE, acute MI and higher THC. These factors have the potential to increase morbidity and mortality of patients with MM and impact their quality of life negatively. MM patients should be monitored for PEM and proper nutrition encouraged to prevent these negative factors. More study needs to be done to identify other factors associated with PEM and MM and identify the reasons for this association.

No relevant conflicts of interest to declare.