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In data presented as an abstract during the 2023 Digestive Disease Week (DDW) in Chicago, a team of investigators led by Miguel Salazar, University of California Riverside, found that patients with acute alcolic hepatitis (AAH) and malnutrition are more likely to suffer from in-hospital mortality

Patients with acute alcoholic hepatitis often also present with malnutrition, most of which require in-hospital care and are diagnosed with some degree of protein calorie malnutrition (PCM).

In the poster, the investigators determined the impact of moderate to severe PCM on outcomes and healthcare resource utilization during in-hospital care of patients with acute alcohol hepatitis.

The Data

In the study, the investigators used data from the National Inpatient Sample (NIS) from 2016-2020 to identify discharges with a diagnosis of AAH and concomitant moderate to severe malnutrition.

The investigators sought primary outcomes of in-hospital mortality and secondary outcomes of rate of post-procedural complications, including endotracheal intubation, acute kidney injury (AKI), shock, encephalopathy, and sepsis.

They also calculated length of stay, total hospital charges, and hospital costs and performed multivariate logistic regression analysis to adjust for potential confounders.

The study included 664,479 patients admitted with AAH, 9.3% (n = 61,894) of which had moderate to severe PCM.

Results

The results show patients with moderate to severe PCM to go along with the AAH were significantly more likely have a number of vitamin deficiencies, including in vitamin D (2.9% vs 1.3%, P <0.01), vitamin B12 (2.7% vs 1.7%, P <0.01), and folate (1.2% vs 0.6%; P <0.01). They were also significantly more likely to have chronic kidney disease (CKD) stage V (1.6% vs 0.5%, P <0.01) and a need for parental nutrition (0.6% vs 0.1%; P <0.01).

This group also had a higher likelihood of suffering acute respiratory failure (adjusted odds ratio [aOR], 2.51, P <0.01), sepsis (aOR, 1.98; P <0.01), bacteremia (aOR, 1.78; P <0.01), spontaneoud bacterial peritonitis (aOR, 2.49; P <0.01), endotracheal intubation (aOR, 2.32; P<0.01), tracheostomy (aOR, 2.56; P <0.01), hemodialysis (aOR, 2.96; P <0.01), acute kidney injuries (aOR, 1.56; P <0.01) shock (aOR, 2.00; P <0.01) paralytic ileus (aOR, 3.09; P <0.01) esophageal varices (aOR, 1.23; P <0.01), transfusion of blood products (aOR, 1.92; P<0.01), hepatic encephalopathy (aOR, 2.04; P <0.01), hepatorenal syndrome (aOR, 1.87; P <0.01), and pleural effusion (aOR, 2.22; P <0.01).

After conducting an adjusted analysis, the investigators found malnourished patients were significantly more likely to die during admission (aOR, 2.46; P <0.01) and had significantly longer hospital length of stay (4.01 days, P <0.01) and significantly higher healthcare charges ($38,754; P <0.01) and hospital costs ($11,479; P <0.01).

“Patients diagnosed with moderate to severe PCM during hospital admission for AAH have higher mortality, longer hospital length of stay and higher healthcare burden,” the authors wrote. “Our study highlights the importance of screening patients with AAH for malnutrition, to institute early nutritional support and begin patients’ education of its poor outcome.”