Abstract 17231: Adult Protein Energy Malnutrition is an Independent Risk Factor With Increased Odds of Cardiogenic Shock in Patients With Infective Endocarditis Who Had Valve Replacement

Abstract

Introduction: Protein Energy Malnutrition (PEM) is common among adults with chronic medical conditions, especially in patients with chronic heart, lung disease and malignancies. These conditions are associated with worse in hospital outcomes. However, the complex relationship between chronic medical conditions and PEM make the true effect of PEM on outcomes difficult to ascertain. This is compounded by the relative underdiagnosis of PEM in adults. Our study aimed to determine if PEM is an independent risk factor for adverse outcomes among patients with infective endocarditis (IE) who had mitral valve (MV) and /or aortic valve (AV) replacement surgery. Methods: Data was obtained from the National Inpatient Sample for 2016 & 2017. Studied cohort were patients with IE who underwent AV and /or MV replacement. This group was divided by presence or absence of PEM using ICD-10 codes. Primary outcome was inpatient mortality. Secondary outcomes were total hospital charges, length of stay (LOS), NSTEMI, post procedural cardiac complications, acute kidney failure (AKI) and need for intra aortic balloon pump (IABP). Multivariate logistic and linear regression models were used to compare outcomes. Results: A total of 4275 hospitalizations met the inclusion criteria, of which about a fifth (20.12%) had PEM.Patients with PEM had higher adjusted odds of post procedural cardiogenic shock (aOR: 3.65, 95% CI: 1.724 - 7.746), and need for IABP placement (aOR: 4.01, 95% CI: 1.958 - 8.199), as well as significantly higher mean difference in total hospital charges and length of stay, relative to patients without PEM. There was however no significant difference in mortality, composite post procedural cardiac complications, NSTEMI or AKI between the PEM and non-PEM subgroup. Conclusion: PEM is associated with post procedural cardiogenic shock and intra-aortic balloon pump placement in patients with infective endocarditis who underwent valve replacement surgery but this impact did not translate to higher mortality. More research is needed to elucidate the role of PEM as a major comorbidity.