PMON63 The Impact of Protein-Energy Malnutrition on Outcomes of Adult Hospitalizations for SIADH: A Nationwide Analysis

Abstract

Abstract Introduction Protein-energy malnutrition (PEM) is a leading cause of morbidity and mortality, particularly in developing countries. Via multiple mechanisms, there is an association between PEM and hyponatremia, but not much is known about concomitant PEM and the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) or the effect of PEM on the outcomes of patients admitted with SIADH. Methods We extracted data from the US Nationwide Inpatient Sample (NIS) for 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for SIADH using the ICD-10-CM code (E22.2). Hospitalizations of patients less than 18 years of age were excluded from the study. This cohort was divided based on the secondary diagnosis of PEM. Outcomes analyzed included comparing inpatient mortality rates, mean length of hospital stay (LOS), mean hospitalization cost (THC), and rates of septic shock, acute myocardial infarction (AMI), acute respiratory failure (ARF), acute renal failure (AKI), acute pulmonary edema (PE) between the subgroups. Adjustments were made for age, sex, race, primary payer, median household income by zip code, Charlson Comorbidity Index (CCI), hospital location, bed-size, and teaching status using multivariate regression analysis. Statistical significance was set at a p-value < 0.05. Results There were 39,110 hospitalizations involving patients with SIADH as the reason for the admission in 2019, and 13.2% of them had comorbid PEM. While both cohorts had a higher proportion of females, the subgroup with comorbid PEM had a lower proportion of females comparatively (57.8 vs 62.3%, p=0.006). There was no significant difference in mean age (72.7±13.6 vs 72.1±12.2 years, p=0.113), but the cohort with PEM had a higher proportion of CCI >2 and more ethnic minorities. In patients with SIADH, PEM was associated with higher adjusted odds ratio (aOR) for mortality (2.53 vs 0.9%, aOR: 2.1, p=0.004), increased LOS (6.6 vs 4.7 days, p<0.001) increased THC (13,884 vs 10,223 US$, p <0.001), and higher odds of comorbid septic shock (8.7 vs 2.8%, aOR: 2.69, p=0.014), CVA (14.6 vs 6.5%, aOR: 2.02, p=0.042), PE (8.7 vs 2.5%, aOR: 2.8, p=0.023) and ARF (13 vs 6.5%, aOR: 1.97, p<0.001), with no significant difference in AKI or AMI odds. Conclusions Comorbid PEM was associated with increased odds of mortality, LOS, THC, septic shock, CVA, PE, and ARF in hospitalizations for SIADH. The mechanism of this association is unclear, but further studies are necessary to better understand this potentially important relationship. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.