David U. Lee, MD, Gregory H. Fan, BA, Raffi Karagozian, MD; Tufts Medical Center, Boston, MA
Introduction: Patients with pancreatic cancer are at risk for malnutrition due to gastric outlet obstruction and altered metabolic homeostasis. Since malnutrition causes immune dysfunction, it is important to evaluate the effect of malnutrition on the infectious outcomes of hospitalized patients with pancreatic cancer. Methods: Hospitalized patients with pancreatic cancer were selected from the 2011-2017 National Inpatient Sample and were stratified by the presence of malnutrition (a composite variable comprised of protein-calorie malnutrition, cachexia/weight loss, and sarcopenia). The endpoints included mortality, length of stay (LOS), hospitalization costs, and infectious outcomes. Univariate and multivariate analyses were performed to identify relationships between the variables. Results: Of the 123443 patients identified as having pancreatic cancer, 31643 patients were identified as also having malnutrition. Compared to the control cohort, the malnutrition cohort was older (68.1 vs 67.8y p< 0.01) and more likely to be male (52.1 vs 50.9% p< 0.01). The mortality rate was higher in the malnutrition cohort (9.93 vs 6.98% p< 0.01, OR 1.47 95%CI 1.40-1.54) as were the LOS (8.22 vs 5.69d p< 0.01) and hospitalization costs ($75,123 vs $54,539 p< 0.01). In terms of local/systemic infections, the malnutrition cohort had higher incidences of sepsis (17.3 vs 11.2% p< 0.01, OR 1.66 95%CI 1.60-1.72), pneumonia (9.17 vs 6.90% p< 0.01, OR 1.36 95%CI 1.30-1.43), urinary tract infection (11.7 vs 9.09% p< 0.01, OR 1.33 95%CI 1.27-1.38), and clostridium difficile infection (1.01 vs 0.54% p< 0.01, OR 1.91 95%CI 1.65-2.2). However, no differences were found in the incidences of cellulitis (2.10 vs 2.27% p=0.07, OR 0.92 95%CI 0.84-1.01) and cholangitis (3.55 vs 3.49% p=0.64, OR 1.02 95%CI 0.95-1.09). In a series of multivariate models using separate endpoints, malnutrition was found to be associated with increased hospital mortality (p< 0.01, aOR 1.14 95%CI 1.08-1.19), sepsis (p< 0.01, aOR 1.41 95%CI 1.35-1.46), pneumonia (p< 0.01, aOR 1.17 95%CI 1.11-1.23), UTI (p< 0.01, aOR 1.21 95%CI 1.16-1.27), and clostridium difficile infection (p< 0.01, aOR 1.66 95%CI 1.43-1.92). Discussion: The presence of malnutrition in patients with pancreatic cancer is associated with an increased risk of hospital mortality and infectious complications. These patients therefore require early nutritional assessment, followed by enteral/parenteral nutritional therapy in order to mitigate infectious risks.
Multivariate model: malnutrition is associated with increased hospital mortality in patients with pancreatic cancer
Multivariate model: malnutrition is associated with sepsis in hospitalized patients with pancreatic cancer
Disclosures: David Lee indicated no relevant financial relationships. Gregory Fan indicated no relevant financial relationships. Raffi Karagozian indicated no relevant financial relationships.