David U. Lee, MD, Gregory H. Fan, BA, Raffi Karagozian, MD; Tufts Medical Center, Boston, MA
Introduction: Patients with esophageal cancer suffer from poor oral intake and malnutrition due to malignant strictures, esophageal dyskinesia, and increased caloric demand from malignant cells. In this study, we evaluate the effect of malnutrition on the outcomes of hospitalized patients with esophageal cancer. Methods: Hospitalized patients with esophageal 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, sarcopenia, and cachexia/weight loss). The endpoints included mortality, length of stay (LOS), hospitalization costs, infectious events, and esophageal complications. Results: A total of 46735 patients with esophageal cancer were identified from the database. The malnutrition cohort (n=16207, 34.7%) was younger (66.2 vs 66.7y p< 0.01) and more likely to be female (23.4 vs 20.7% p< 0.01). The mortality rate was higher in the malnutrition cohort (11.1 vs 8.09% p< 0.01, OR 1.42 95%CI 1.33-1.51), as were the LOS (8.73 vs 6.11d p< 0.01) and total hospitalization costs ($83,815 vs $62,957 p< 0.01). In terms of infectious outcomes, the malnutrition cohort had higher incidences of sepsis (15.0 vs 9.32% p< 0.01, OR 1.72 95%CI 1.63-1.82), candida esophagitis (1.81 vs 0.95% p< 0.01, OR 1.92 95%CI 1.63-2.26), pneumonia (15.5 vs 12.4% p< 0.01, OR 1.3 95%CI 1.23-1.37), urinary tract infection (7.54 vs 6.02% p< 0.01, OR 1.27 95%CI 1.18-1.37), and clostridium difficile infection (0.92 vs 0.40% p< 0.01, OR 2.29 95%CI 1.81-2.91). The malnutrition cohort had higher rates of esophageal complications, including esophageal ulcerations (2.34 vs 1.99% p< 0.01, OR 1.18 95%CI 1.04-1.34), esophageal perforations (1.28 vs 0.70% p< 0.01, OR 1.82 95%CI 1.51-2.21), and esophageal dyskinesia (0.47 vs 0.29% p< 0.01, OR 1.65 95%CI 1.21-2.24). In a series of multivariate models with separate endpoints, malnutrition was found to be associated with mortality (p< 0.01, aOR 1.21 95%CI 1.13-1.3), sepsis (p< 0.01, aOR 1.55 95%CI 1.45-1.65), and esophageal perforation (p< 0.01, aOR 1.56 95%CI 1.28-1.90). Discussion: Malnourished patients with esophageal cancer are at an increased risk for hospital mortality, infections, and esophageal complications. These patients therefore require early risk-assessment, followed by goal-directed nutritional therapy and surveillance of infectious/esophageal complications.
Multivariate model: malnutrition is associated with increased mortality in hospitalized patients with esophageal cancer
Multivariate model: malnutrition is associated with sepsis in hospitalized patients with esophageal cancer
Multivariate model: malnutrition is associated with esophageal perforation in hospitalized patients with esophageal cancer
Disclosures: David Lee indicated no relevant financial relationships. Gregory Fan indicated no relevant financial relationships. Raffi Karagozian indicated no relevant financial relationships.