Impact of Malnutrition and Interventions on Patients Receiving Heart Transplant

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The purpose of this study is to assess the impact of malnutrition on in-hospital outcomes in patients receiving a heart transplant, and if there is any benefit from acute nutritional intervention. We analyzed data from the National Inpatient Sample from the years 2012 to 2015. Using appropriate ICD-9-CM codes, we screened for all patients age > 18 who received a heart transplant (n = 7,940) during the study period. Patients were then separated into two groups, those with a diagnosis of malnutrition (n = 1,515) and those without, who were deemed well nourished (n = 6,425). ICD-9-CM codes for sepsis, acute kidney injury (AKI) requiring dialysis, and mechanical circulatory support (MCS) of all types were used to further characterize patients. Stratified analysis was performed for malnourished patients who received nutritional supplementation. Malnourished patients had higher rates of in-hospital mortality (8.9% vs 5.3%), sepsis (31.0% vs 13.5%, p < 0.001), AKI requiring dialysis (4.6% vs 3.6%, p < 0.001), need for any form of MCS (35.6% vs 18.4%, p < 0.001). Among malnourished patients, those who received nutritional supplementation had lower rates of in-hospital death (7.1% vs 9.0%, p < 0.001) and sepsis (7.1% vs 32.3%, p < 0.001). In a multivariate logistic regression model, malnutrition had an adjusted odds ratio of 1.742 for mortality in this patient population [95% CI 1.081 - 2.806; p < 0.001]. This is the largest study assessing the impact of malnutrition on cardiac transplant recipients. Patients with a diagnosis of malnutrition who receive a heart transplant have significantly higher rates of in-hospital mortality, sepsis, AKI requiring dialysis, and need for MCS. Among patients who were malnourished, those who received nutritional supplementation had significantly lower rates of in-hospital mortality and sepsis. It may be reasonable to consider implementing additional screening and treatment for malnutrition in patients receiving a cardiac transplant.