S796 Severe Protein-Calorie Malnutrition Increases Mortality in Patients Admitted With Intestinal Obstruction Secondary to Crohn’s Disease: A Nationwide Analysis

Abstract

Introduction: The prevalence of malnutrition in Crohn’s disease (CD) ranges between 20% and 85%. Poor nutritional status, as well as selective malnutrition or sarcopenia, is associated with poor clinical outcomes, response to therapy and quality of life. We queried the effect of severe protein-calorie malnutrition (PCM) in patients hospitalized with bowel obstruction secondary to CD. Methods: A retrospective cohort study of the 2016-2017 National Inpatient Sample database was performed, using ICD10-CM/PCS codes to identify patients discharged with a primary diagnosis fibro-stenotic CD and those with a secondary diagnosis of severe PCM. Primary endpoint was in-hospital mortality. Secondary endpoints were length of stay (LOS), in-hospital complications, advanced therapy and hospital related charges. Multivariate regression analysis models to adjust for patient and hospital characteristics and were performed for both primary and secondary outcomes. Results: Of 33,495 patients were discharged with bowel obstruction secondary to CD, 11.3% (3,780) had severe PCM. These patients were more likely to be African American (10.0% vs 12.5%; P = 0.03), had a Charlson score of >3 (3.8% vs 8.2%; P < 0.01), belong to the lower income bracket (21.3% vs 25.3%; P < 0.01), have Medicare (23.5% vs 30.5%; P < 0.01), live on the western US (14.9% vs 18.2%; P = 0.02), be admitted to a large hospital (51.9% vs 62.9%;P < 0.01). Severe PCM patients were more likely to abuse opiates (2.0% vs 4.3%; P < 0.01) and cannabis (2.4% vs 4.2%; P < 0.01), have chronic kidney disease (3.4% vs 5.4%; P < 0.01), require transfusion of blood products (1.6% vs 7.1%; P < 0.01) and parenteral nutrition (1.8% vs 18.4%; P < 0.01). On multivariate analysis, severe PCM patients had higher mortality [OR 4.57; (P < 0.01)] and significant health care burden, including LOS [5.81 days; (P < 0.01)], hospitalization charges [$52,655; (P < 0.01)] and costs [$13,449; (P < 0.01)]. They also had worse clinical outcomes included intubation [ OR 7.59; (P < 0.01)], prolonged mechanical ventilation [OR 14.91; (P < 0.01)], AKI [OR 2.55; (P < 0.01)], shock [OR 16.01; (P < 0.01)], sepsis [OR 3.09; (P < 0.01)], acute respiratory failure [OR 9.67; (P < 0.01)] and venous thromboembolic events (VTE) [OR 7.37; (P < 0.01)]. Conclusion: Severe PCM poses increased mortality and health care burden in patients admitted with bowel obstruction in CD, through worse inpatient clinical outcomes and complications.Table 1.: Comparison of Demographics, Traditional and Non-Traditional Risk Factors between IBD and Non IBD patients