Impact of protein-energy malnutrition on patients with breast cancer hospitalized for acute decompensated heart failure: Insight from the NIS database 2020.

person Elvis Obomanu Department of Internal Medicine, Jefferson-Einstein Hospital, Philadelphia, PA info_outline Elvis Obomanu, Phuuwadith Wattanachayakul, Colton Jones, Yajur Arya, Arshi Syal, Karecia Byfield, Sarah Eidbo, Akshay Ratnani, Sakditad Saowapa, Natchaya Polpichai, Chalothorn Wannaphut, Carlo Casipit, Bruce Adrian Casipit, Ryan Mayo

Authors person Elvis Obomanu Department of Internal Medicine, Jefferson-Einstein Hospital, Philadelphia, PA info_outline Elvis Obomanu, Phuuwadith Wattanachayakul, Colton Jones, Yajur Arya, Arshi Syal, Karecia Byfield, Sarah Eidbo, Akshay Ratnani, Sakditad Saowapa, Natchaya Polpichai, Chalothorn Wannaphut, Carlo Casipit, Bruce Adrian Casipit, Ryan Mayo Organizations Department of Internal Medicine, Jefferson-Einstein Hospital, Philadelphia, PA, Department of Internal Medicine,Jefferson-Einstein Hospital, Philadelphia, PA, Jefferson Einstein Hospital, Philadelphia, PA, Department of Medicine, Texas Tech University, Lubbock, TX, Department of Medicine, Weiss Memorial Hospital, Chicago, IL, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, Depatment of Hematology-Oncology, Jefferson-Einstein Hospital, Philadelphia, PA Abstract Disclosures Research Funding No funding sources reported Background: The breast cancer patient is at risk of acute decompensated heart failure (ADHF) and protein-energy malnutrition (PEM) either from the effects of chemoradiation or primary cancer. There have been several studies on patients with breast cancer and ADHF. However, the exact impact of concurrent PEM on patients with breast cancer admitted for ADHF is unclear. We aim to assess how PEM impacts breast cancer patients admitted with ADHF. Methods: We examined the 2020 US National Inpatient Sample (NIS) to explore how concurrent PEM affects breast cancer patients admitted for ADHF. Participants aged 18 and older were identified using relevant ICD-10 CM codes. A survey multivariate logistic and linear regression analysis was used to calculate the odds ratio (OR) for the outcomes of interest. Results: We identified 30,555 breast cancer patients with ADHF, with a mean age of 77±10 years; 99% were female. Caucasian accounted for 71.4%, followed by Black (17.5%), Mexican American (5%), and Asian (3%). Of these, 6.07% (1854/30,555) had a concurrent PEM diagnosis. In a survey multivariable regression model adjusting for patient and hospital factors, comorbid PEM was significantly associated with prolonged length of stay (β 2.09, 95% CI: 1.68–2.49, P <0.001), increased risk of in-hospital mortality (aOR 2.61, 95% CI: 1.60–4.29, P <0.001), increased risk of cardiogenic shock (aOR 3.17, 95% CI: 1.78–2.59, P< 0.001), anemia (aOR 1.43, 95% CI: 1.14 to 1.80, p 0.002), and total hospital charge $28,285 (95% CI: $21,743–34,827, P< 0.001). Adverse events such as respiratory failure (aOR 1.17, 95% CI 0.91 to 1.50, p 0.212) and DVT (aOR 1.15, 95% CI 0.40 to 3.31, p 0.802) were observed but did not reach statistical significance. Conclusions: Our study demonstrated that comorbid PEM among hospitalized breast cancer patients for ADHF is associated with increased risks of in-hospital mortality, anemia, cardiogenic shock, prolonged length of hospital stays, and total hospital charges. The study also highlights that nutritional status may be a useful prognostic marker in breast cancer patients who are at risk for various cardiovascular morbidities associated with cancer treatment and the primary disease. Additional longitudinal cohort studies are required to improve the understanding of this association.