S0058 The Prevalence and Burden of Protein Energy Malnutrition Among Patients Hospitalized for Chronic Pancreatitis in the United States

Abstract

INTRODUCTION: Chronic pancreatitis (CP) is associated with inflammatory destruction of the pancreas, suboptimal digestion, and absorption of nutrients, resulting in an elevated risk of Protein Energy Malnutrition (PEM). We sought to provide a national estimate of the prevalence, trends, characteristics, and the burden of PEM among patients hospitalized for CP. METHODS: Adult (age ≥18 years) hospital records were selected from the Nationwide Inpatient Sample (2007–2014). The prevalence and trends of PEM was calculated, stratified by concomitant presence of CP, and the impact of CP on the trends of PEM was measured. Among patients hospitalized for CP (Nationwide Inpatient Sample, 2012–2014), those with concomitant PEM and its associated factors (demographic, hospital, and co-morbid) were identified. CP patients with PEM were propensity-matched (1:1) to those without PEM, and the impact of PEM on clinical outcomes were estimated (SAS 9.4). RESULTS: From 2007–2014 (Figure 1A), the average prevalence of PEM was 506 per 10,000 hospitalizations, increasing from 337/10,000 (2007) to 626/10,000 (2014). The annual rate of increase in PEM was steeper (2.3x higher, Figure 1B) among patients with CP vs. no-CP (93/10,000 vs. 41/10,000 hospitalization/year). From 2012–2014, 11.5% (3,694 of 32,024) of CP hospitalizations had concomitant PEM, which was higher than patients without CP (5%) or with cirrhosis (6.1%). Odds for PEM was higher among Whites, advanced age, Medicare-insured, low-income earners, non-Northeastern regions, and patients with multiple co-morbidities such as alcohol and tobacco use, biliary stones, malignancies, and chronic diseases of the lung, heart, liver, and kidney. After propensity-matching, concomitant PEM was associated with very poor outcomes (Figure 2), including: mortality (AOR: 3.55 [95% CI: 1.73–7.31], P < 0.0001), acute kidney injury (AOR: 1.48 [95% CI: 1.28–1.70], P < 0.0001), parenteral nutrition (AOR: 5.58 [95% CI: 4.47–6.97], P < 0.0001), longer hospital stay (PEM: 8.3- vs. no-PEM: 4.8-days P < 0.0001), higher charges (PEM: US$59,334 vs. no-PEM: US$33,249 P < 0.0001) and higher discharge to secondary facilities (AOR: 1.74 [95% CI: 1.53–1.97], P < 0.0001). CONCLUSION: In conclusion, there is a higher prevalence and steeper increase of PEM among patients with CP than the general population. PEM is associated with higher mortality and poorer outcomes. Prevention, early recognition, and treatment of PEM among the high-risk categories may curb these dismal outcomes.Figure 1.: A: Increasing trend in the rate of PEM among Hospitalized Patients in the US (2007 to 2014). B: Among hospitalized patients, frequency and rate of increase in PEM is higher among patients with chronic pancreatitis (2007 to 2014).Figure 2.: Impact of Protein Energy Malnutrition on Outcomes of Hospitalizations for Chronic Pancreatitis.