(8.09) Impact of protein energy malnutrition in patients hospitalized with adrenal insufficiency- A nationwide analysis.

 Adrenal insufficiency (AI) is relatively uncommon yet potentially life-threatening if left undiagnosed and untreated. Protein-energy malnutrition (PEM) is frequently encountered in hospitalized patients, yet a comprehensive exploration of its impact on those with AI utilizing a large database is lacking. We aim to study trends and inpatient outcomes of protein energy malnutrition in patients admitted with adrenal insufficiency.

Methods:

Retrospective data on adult patients (age >18) with a primary diagnosis of AI was extracted between 2017 and 2020 using the National Inpatient Sample (NIS). The STATA data analysis tool was employed. Diseases and outcome codes were selected using the International Classification of Diseases (ICD-10). Multivariate regression analysis was applied to adjust for potential confounders and determine the adjusted odds ratio (aOR). The Fisher exact test was utilized to compare proportions, while the student t-test was used to compare continuous variables. The primary outcome was mortality; additional secondary outcomes included length of stay (LOS), total hospitalization costs, acute coronary syndrome (ACS), septic shock, pulmonary edema, acute respiratory failure (ARF), mechanical ventilation, acute respiratory distress syndrome (ARDS), acute kidney injury (AKI), and cerebrovascular accidents (CVA).

Results:

A total of 150,005 patients were diagnosed with AI, of whom 17,545 were identified with PEM. The mean age of patients with Protein-Energy malnutrition (PEM) was 61 years, compared to 59 years without PEM. PEM was prevalent in female patients with adrenal insufficiency (54.89 % vs. 45.11 %). Patients with PEM exhibited higher rates of mortality (aOR=2.88, 8.56% vs. 2.80%, p< 0.001), increased LOS (adjusted mean difference=6.73, 13.41 days vs. 6.16 days, p< 0.001), and elevated total hospitalization expenses (adjusted mean difference=$96,375, $180,253 vs. $76,264, p< 0.001). Significant differences were noted in outcomes such as ACS (aOR=1.39, 1.37% vs.0.86%, p< 0.05), septic shock (aOR=3.27, 16.56% vs. 5.18%, p< 0.001), pulmonary edema (aOR=3.08, 0.83% vs. 0.26%, p< 0.001), ARF (aOR=2.02, 18.44% vs. 9.23%, p< 0.001), mechanical ventilation(aOR=2.61, 11.43% vs.4.27%, p< 0.001), ARDS (aOR=2.93, 1.03% vs. 0.29%, p< 0.001), AKI( aOR=1.67, 34.54% vs. 21.54%, p< 0.001), and CVA(aOR=1.89, 1.60% vs. 0.66%, p< 0.001) compared to patients without PEM.

Discussion/Conclusion:

Protein-energy malnutrition escalates mortality, morbidity, health care burden, and resource utilization in patients with adrenal insufficiency. We recommend screening for PEM in patients with AI. Early referral or dietician participation may mitigate adverse outcomes.  Further investigation is warranted to understand the relationship between PEM and AI and to develop early detection and treatment strategies.