Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein-Energy Malnutrition.
charges
discharge disposition
length of stay
mortality
shock
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
28
09
2018
accepted:
28
06
2019
pubmed:
19
7
2019
medline:
4
3
2021
entrez:
19
7
2019
Statut:
ppublish
Résumé
Protein-energy malnutrition (PEM) diminishes amino acid and energy availability, impairing the body's healing capability after injury, such as in myocardial damage following acute myocardial infarction (AMI). We sought to investigate the influence of PEM on clinical outcomes of AMI. We identified records with a primary discharge diagnosis of AMI from the Nationwide Inpatient Sample (2012-2014), stratified by concomitant PEM. We matched PEM to no-PEM (1:1) using a greedy algorithm-based propensity methodology and estimated the impact of PEM on health outcomes (SAS 9.4). Of the 332,644 hospitalizations for AMI, 11,675 had concomitant PEM accounting for roughly $US 1.5 billion and over 119,792 hospital days. PEM was associated with older age (74.43- vs. 66.90-years; P < 0.0001), female sex (49.19% vs. 38.44%; P < 0.0001), black race (12.78% vs. 10.46%; P < 0.0001), and higher comorbidity burden (Deyo > 3: 32.77% vs. 16.69%; P < 0.0001). After propensity matching, PEM was associated with higher mortality (Adjusted odds ratio [AOR]: 1.59 [1.46-1.73]), cardiogenic shock (AOR: 2.26 [2.08-2.44]), discharge to secondary facilities (AOR: 2.21 [2.10-2.33]), charges ($135,500 [$131,956-139,139] vs. $81,084 [$79,241-82,970]), cardiac artery bypass surgery (AOR:1.81 [1.66-1.97]), intra-aortic balloon pump placement (AOR: 1.83 [1.65-2.04]) and longer length of stay (10.15- vs. 5.52-days). PEM is a predisposing factor for devastating clinical outcomes among AMI hospitalizations. Higher prevention, identification and management of PEM among high-risk individuals (older age, female sex, and black race) residing in the community are needed.
Sections du résumé
BACKGROUND
Protein-energy malnutrition (PEM) diminishes amino acid and energy availability, impairing the body's healing capability after injury, such as in myocardial damage following acute myocardial infarction (AMI).
AIMS
We sought to investigate the influence of PEM on clinical outcomes of AMI.
METHODS
We identified records with a primary discharge diagnosis of AMI from the Nationwide Inpatient Sample (2012-2014), stratified by concomitant PEM. We matched PEM to no-PEM (1:1) using a greedy algorithm-based propensity methodology and estimated the impact of PEM on health outcomes (SAS 9.4).
RESULTS
Of the 332,644 hospitalizations for AMI, 11,675 had concomitant PEM accounting for roughly $US 1.5 billion and over 119,792 hospital days. PEM was associated with older age (74.43- vs. 66.90-years; P < 0.0001), female sex (49.19% vs. 38.44%; P < 0.0001), black race (12.78% vs. 10.46%; P < 0.0001), and higher comorbidity burden (Deyo > 3: 32.77% vs. 16.69%; P < 0.0001). After propensity matching, PEM was associated with higher mortality (Adjusted odds ratio [AOR]: 1.59 [1.46-1.73]), cardiogenic shock (AOR: 2.26 [2.08-2.44]), discharge to secondary facilities (AOR: 2.21 [2.10-2.33]), charges ($135,500 [$131,956-139,139] vs. $81,084 [$79,241-82,970]), cardiac artery bypass surgery (AOR:1.81 [1.66-1.97]), intra-aortic balloon pump placement (AOR: 1.83 [1.65-2.04]) and longer length of stay (10.15- vs. 5.52-days).
CONCLUSIONS
PEM is a predisposing factor for devastating clinical outcomes among AMI hospitalizations. Higher prevention, identification and management of PEM among high-risk individuals (older age, female sex, and black race) residing in the community are needed.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
454-462Informations de copyright
© 2019 American Society for Parenteral and Enteral Nutrition.
Références
Skipper A. Agreement on defining malnutrition. J Parenter Enter Nutr. 2012;36(3):261-262.
Marshall S. Protein-energy malnutrition in the rehabilitation setting: evidence to improve identification. Maturitas. 2016;86:77-85.
Norman K, Pichard C, Lochs H, et al. Prognostic impact of disease-related malnutrition. Clin Nutr Edinb Scotl. 2008;27(1):5-15.
Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet. 2017;389(10065):197-210.
Khare M, Mohanty C, Das BK, et al. Free radicals and antioxidant status in protein energy malnutrition. Int J Pediatr. 2014;2014:254396.
Shrivastava K, Gaur A, Ambey R. Oxidative stress in children with severe acute malnutrition between 6 months to 5 years of age. Int J Contemp Pediatr. 2018;5(4):1327-1329.
Mastorci F, Vassalle C, Chatzianagnostou K, et al. Undernutrition and overnutrition burden for diseases in developing countries: the role of oxidative stress biomarkers to assess disease risk and interventional strategies. Antioxidants. 2017;6(2):41.
Braunersreuther V, Jaquet V. Reactive oxygen species in myocardial reperfusion injury: from physiopathology to therapeutic approaches. Curr Pharm Biotechnol. 2012;13(1):97-114.
Zhou T, Prather ER, Garrison DE, et al. Interplay between ROS and antioxidants during ischemia-reperfusion injuries in cardiac and skeletal muscle. Int J Mol Sci. 2018;19(2):pii E417.
Gariballa SE, Parker SG, Taub N, et al. Influence of nutritional status on clinical outcome after acute stroke. Am J Clin Nutr. 1998;68(2):275-281.
HCUP-US NIS. Overview. https://www.hcup-us.ahrq.gov/nisoverview.jsp#data. Accessed December 14, 2017.
McCormick N, Lacaille D, Bhole V, et al. Validity of myocardial infarction diagnoses in administrative databases: a systematic review. PLoS One. 2014;9(3):e92286.
Metcalfe A, Neudam A, Forde S, et al. Case definitions for acute myocardial infarction in administrative databases and their impact on in-hospital mortality rates. Health Serv Res. 2013;48(1):290-318.
Adejumo AC, Akanbi O, Pani L. Among inpatients, ischemic bowel disease predisposes to Clostridium difficile infection with concomitant higher mortality and worse outcomes. Eur J Gastroenterol Hepatol. 2019;31(1):109-115.
Adegbala O, Olagoke O, Akintoye E, et al. Predictors, burden, and the impact of arrhythmia on patients admitted for acute myocarditis. Am J Cardiol. 2019;123(1):139-144.
Adejumo AC, Ajayi TO, Adegbala OM, et al. Cannabis use is associated with reduced prevalence of progressive stages of alcoholic liver disease. Liver Int. 2018;38(8):1475-1486.
Adegbala O, Olagoke O, Adejumo A, et al. Regional disparity in outcomes among patients hospitalized for Takotsubo cardiomyopathy in the United States✰. Heart Lung. 2019;48(2):79-84.
Adejumo AC, Akanbi O, Adejumo KL, et al. Reduced risk of alcohol-induced pancreatitis with cannabis use. Alcohol Clin Exp Res. 2019;43(2):277-286.
Adegbala O, Adejumo AC, Olakanmi O, et al. Relation of cannabis use and atrial fibrillation among patients hospitalized for heart failure. Am J Cardiol. 2018;122(1):129-134.
Nguyen GC, Munsell M, Harris ML. Nationwide prevalence and prognostic significance of clinically diagnosable protein-calorie malnutrition in hospitalized inflammatory bowel disease patients. Inflamm Bowel Dis. 2008;14(8):1105-1111.
Sam J, Nguyen GC. Protein-calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension. Liver Int. 2009;29(9):1396-1402.
White JV, Guenter P, Jensen G, et al. Consensus statement: academy of nutrition and dietetics and American Society for Parenteral and Enteral Nutrition. J Parenter Enter Nutr. 2012;36(3):275-283.
Corkins MR, Guenter P, DiMaria-Ghalili RA, et al. Malnutrition diagnoses in hospitalized patients: United States, 2010. J Parenter Enteral Nutr. 2014;38(2):186-195.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130-1139.
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-619.
Elixhauser A, Steiner C, Harris DR, et al. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8-27.
Southern DA, Quan H, Ghali WA. Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data. Med Care. 2004;42(4):355-360.
Hammill B. GMATCH SAS macro: computerized matching of cases to controls using the greedy matching algorithm with a fixed number of controls per case. http://people.duke.edu/~hammill/software/gmatch.sas Accessed February 28, 2018.
Kitsios GD, Dahabreh IJ, Callahan S, et al. Can we trust observational studies using propensity scores in the critical care literature? A systematic comparison with randomized clinical trials. Crit Care Med. 2015;43(9):1870-1879.
Yoo SH, Kook HY, Hong YJ, et al. Influence of undernutrition at admission on clinical outcomes in patients with acute myocardial infarction. J Cardiol. 2017;69(3):555-560.
Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82(4):777-783.
Nickols-Richardson SM, Johnson MA, Poon LW, et al. Demographic predictors of nutritional risk in elderly persons. J Appl Gerontol. 1996;15(3):361-375.
Sujino Y, Tanno J, Nakano S, et al. Impact of hypoalbuminemia, frailty, and body mass index on early prognosis in older patients (≥85 years) with ST-elevation myocardial infarction. J Cardiol. 2015;66(3):263-268.
Lee S-H, Park J-S, Kim W, et al. Impact of body mass index and waist-to-hip ratio on clinical outcomes in patients with ST-segment elevation acute myocardial infarction (from the Korean acute myocardial infarction registry). Am J Cardiol. 2008;102(8):957-965.
Chen Q-J, Qu H-J, Li D-Z, et al. Prognostic nutritional index predicts clinical outcome in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Sci Rep. 2017;7(1):3285.
Adejumo OL, Koelling TM, Hummel SL. Nutritional risk index predicts mortality in hospitalized advanced heart failure patients. J Heart Lung Transplant. 2015;34(11):1385-1389.
Webb JG, Kiess MC, Chan-Yan CC. Malnutrition and the heart. CMAJ Can Med Assoc J. 1986;135(7):753-758.
Lew CCH, Yandell R, Fraser RJL, et al. Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review. J Parenter Enter Nutr. 2017;41(5):744-758.
Isabel T. D., Correia M, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235-239.
Carvalho-Salemi J, Salemi JL, Wong-Vega MR, et al. Malnutrition among hospitalized children in the United States: changing prevalence, clinical correlates, and practice patterns between 2002 and 2011. J Acad Nutr Diet. 2018;118(1):40-51.e7.
Bistrian BR, Blackburn GL, Hallowell E, et al. Protein status of general surgical patients. JAMA. 1974;230(6):858-860.
Bistrian BR, Blackburn GL, Vitale J, et al. Prevalence of malnutrition in general medical patients. JAMA. 1976;235(15):1567-1570.
Somanchi M, Tao X, Mullin GE. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition. J Parenter Enteral Nutr. 2011;35(2):209-216.
Heart Attack Facts & Statistics | cdc.gov. https://www.cdc.gov/heartdisease/heart_attack.htm. Published August 18, 2017. Accessed September 21, 2018.
Bally MR, Yildirim PZB, Bounoure L, et al. Nutritional support and outcomes in malnourished medical inpatients: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(1):43-53.
Niccoli S, Kolobov A, Bon T, et al. Whey protein supplementation improves rehabilitation outcomes in hospitalized geriatric patients: a double blinded, Randomized Controlled Trial. J Nutr Gerontol Geriatr. 2017;36(4):149-165.
Yoshimura Y, Uchida K, Jeong S, et al. Effects of nutritional supplements on muscle mass and activities of daily living in elderly rehabilitation patients with decreased muscle mass: a randomized controlled trial. J Nutr Health Aging. 2016;20(2):185-191.
Adejumo AC, Adejumo KL, Adegbala OM, et al. Protein-energy malnutrition and outcomes of hospitalizations for heart failure in the USA. Am J Cardiol. 2019;123(6):929-935.
Adejumo AC, Alliu S, Ajayi TO, et al. Cannabis use is associated with reduced prevalence of non-alcoholic fatty liver disease: a cross-sectional study. PLoS One. 2017;12(4):e0176416.
Adejumo AC, Li J, Akanbi O, et al. Reduced prevalence of alcoholic gastritis in hospitalized individuals who consume cannabis. Alcohol Clin Exp Res. 2019;43(2):270-276.