Impact of protein-energy malnutrition on outcomes of patients with diffuse large B cell lymphoma admitted for inpatient chemotherapy

Abstract

Background Protein-energy malnutrition (PEM) is a major factor contributing to morbidity and mortality in cancer patients. Empiric data are limited on the effect of PEM on the outcomes of patients receiving chemotherapy in diffuse large B cell lymphoma (DLBCL). Methods A retrospective cohort study was designed using data from the National Inpatient Sample for 2016 to 2019. Adult patients admitted for chemotherapy with DLBCL were stratified based on the presence of PEM. Primary outcomes assessed were mortality, length of stay, and total hospital charges. Results PEM was associated with an increased odds of mortality, 2.21% vs 0.25% (adjusted odds ratio 8.20, P < 0.001, 95% confidence interval [CI] 4.92–13.69). There was also an increased length of stay in patients with PEM, 7.89 vs 4.85 days (adjusted difference of 3.01 days, P < 0.001, 95% CI 2.37–3.66), as well as an increase in total charges, $137,940 vs $69,744 (adjusted difference of $65,427, P < 0.001, 95% CI $38,075–$92,778). Similarly, the presence of PEM was associated with increased odds of several secondary outcomes measured, including neutropenia, Candida sepsis, septic shock, acute respiratory failure, and acute kidney injury compared to the other cohort. Conclusion This study demonstrated an eightfold increased odds of mortality and concomitant prolonged length of stay with a 50% total charge increment in malnourished individuals with DLBCL compared to those without PEM. Prospective trials to evaluate PEM as an independent prognostic marker of chemotherapy tolerance and adequate nutritional support can improve clinical outcomes.