S1114 Protein-Calorie Malnutrition Is Associated With Worse Outcomes in Patients Admitted With Acute Cholangitis Undergoing Endoscopic Retrograde Cholangiopancreaticography

Abstract

Introduction: Acute cholangitis, often caused by biliary obstruction, can lead to sepsis and death due to multiorgan failure. Endoscopic retrograde cholangiopancreatography (ERCP) is the recommended first line therapeutic modality in the management of acute cholangitis. ERCP can be associated with complications such as pancreatitis, perforation, and bleeding. Protein-calorie malnutrition (PCM) is associated with poor clinical outcomes in hospitalized patients. The aim of this study is to elucidate the relationship between PCM and patients undergoing ERCP for acute cholangitis. Methods: Data were extracted from the National Inpatient Sample (NIS) database in the period between 2016 to 2019. Using the International Classification of Diseases, 10th revision, and Clinical Modification (ICD-10-CM) codes to obtain baseline demographic and clinical data, in-hospital mortality, hospital charges, and hospital length of stay (LOS). Statistical analysis was completed using t-test and Chi-squared analyses. Multivariate analysis for the mortality odds ratio (OR) was calculated after adjusting for potential confounders. Results: A total of 123,285 patients with ascending cholangitis underwent ERCP, and 11,135 (9%) of these patients had PCM. The mean age of the PCM group was 68.15 years which was not significantly different from the non-PMN group (p-value 0.86). Most patients in the PCM group were males (56%) and whites (62.6%). More patients in the PCM group were alcoholics, had diabetes mellitus, congestive heart failure (CHF), and cirrhosis compared to the non-PCM group. After controlling for potential confounders, PCM was associated with higher in-hospital mortality (OR 3.4, CI 2.85-4.04; p< 0.01). Moreover, patients with PCM had higher total hospital charges ($175,726 vs. $82,824; P< 0.01), and a longer LOS (12.7 vs 6.1 days; P< 0.01). In addition to malnutrition, age > 65 years, non-white race, cirrhosis, and CHF were independently associated with higher in-hospital mortality (Table). Conclusion: PCM is a strong predictor of poor clinical outcomes in patients with acute cholangitis admitted for ERCP. Systemic comorbidities such as cirrhosis and CHF are often associated with diminished nutritional states which may explain the higher prevalence of in-hospital mortality in the study group. Nutritional status is a modifiable risk factor and should be optimized to improve clinical outcomes in hospitalized patients with cholangitis. Table 1. - Univariate and multivariate analysis of factors affecting in-hospital mortality in patients with acute cholangitis undergoing ERCP Variable Univariate Multivariate OR (CI 95%) P-value OR (CI 95%) P-value Protein-calorie malnutrition 3.66 (3.08-4.34) < 0.01 3.4 (2.85-4.04) < 0.01 Age > 65 1.47 (1.25-1.73) < 0.01 1.38 (1.16-1.64) < 0.01 Female 1.06 (0.91-1.22) 0.41 1.06 (0.91-1.23) 0.436 Non-White 1.24 (1.06-1.44) < 0.01 1.25 (1.07-1.46) < 0.01 Alcoholism 1.4 (1.03-1.9) 0.02 1.32 (0.94-1.84) 0.1 Cirrhosis 2.18 (1.68-2.82) < 0.01 1.89 (1.82-2.6) < 0.01 Congestive heart failure 2.38 (2.02-2.82) < 0.01 2.17 (1.42-2.52) < 0.01 Smoking 0.57 (0.48-0.68) < 0.01 0.6 (0.5-0.71) < 0.01