Malnutrition Linked to Increased Mortality, Infection Risk in Alcoholic Hepatitis

alcohol liver disease
alcohol liver disease
A team of researchers sought to determine the effects of malnutrition on the risk for infection in patients hospitalized with alcoholic hepatitis.

Malnutrition is an independent risk factor for mortality and local and systemic infections in patients hospitalized with alcoholic hepatitis, according to a study in the Journal of Clinical Gastroenterology.

Researchers analyzed discharge data from the 2011 to 2017 editions of the National Inpatient Sample (NIS) database. Eligible participants had a discharge diagnosis of alcoholic hepatitis and were aged at least 18 years.

The study population was stratified into a malnutrition-present cohort and a malnutrition-absent cohort. Case-cohort matching was conducted using the nearest neighbor algorithm with age, sex, and race as the input variables to match patients with control individuals 1:1. Study endpoints included mortality and various infections.

The prematch comparison included 10,520 patients with malnutrition and 81,352 malnutrition-absent control individuals. The postmatch analysis compared 10,520 malnutrition patients with 10,520 matched control individuals. The prematch analysis showed that the malnutrition cohort vs the control group was more likely to be older (50.8 vs 47.3 years, P <.001) and to be women (39.60 vs 30.10, P <.001).

In the prematch and postmatch analyses, the malnutrition cohort had higher incidences of mortality (prematch: 5.02 vs 1.95%; P <.001; odds ratio [OR], 2.66; 95% CI, 2.40-2.94; postmatch: 5.02 vs 2.29%; P <.001; OR, 2.25; 95% CI, 1.93-2.63), longer length of stay (prematch: 9.14 vs 5.03 days; P <.001; postmatch: 9.14 vs 5.17 days; P <.001), and higher hospitalization costs (prematch: $73,964 vs $38,431; P <.001; postmatch: $73,964 vs $39,149; P <.001).

In multivariate analysis that used infectious endpoints as separate dependent variables, malnutrition was associated with infectious endpoints with the following estimated risks: sepsis (prematch: P <.001; adjusted odds ratio [aOR], 2.41; 95% CI, 2.25-2.58; postmatch: P <.001; aOR, 2.42; 95% CI, 2.18-2.69), pneumonia (prematch: P <.001; aOR, 2.16; 95% CI, 2.01-2.33; postmatch: P <.001; aOR, 2.19; 95% CI, 1.96-2.46), urinary tract infection (prematch: P <.001; aOR, 1.63; 95% CI, 1.53-1.74; postmatch: P <.001; aOR, 1.68; 95% CI, 1.53-1.84), cellulitis (prematch: P <.001; aOR, 1.45; 95% CI, 1.28-1.64; postmatch: P <.001; aOR, 1.46; 95% CI, 1.22-1.74), cholangitis (prematch: P =.001; aOR, 1.68; 95% CI, 1.23-2.29; postmatch: P =.002; aOR, 2.27; 95% CI, 1.36-3.80), and Clostridium difficile infection (prematch: P <.001; aOR, 2.11; 95% CI, 1.77-2.51; postmatch: P <.001; aOR, 1.89; 95% CI, 1.46-2.44). These data resulted after controlling for medical covariates, demographics, hepatic events, and liver-related variables.

The researchers noted that the NIS database does not include information separate from International Classification of Diseases diagnosis codes, such as patient medication history, biomarkers, and other laboratory findings used to measure the severity of malnutrition. Instead, surrogate diagnostic variables of usual manifestations of moderate-to-severe malnutrition were used to maximize the diagnostic yield of malnutrition cases.

“The presence of malnutrition resulted in higher hospital mortality and local/systemic infections in patients with alcoholic hepatitis,” the study authors wrote. “Given this finding, patients with malnutrition should be identified early in their admission so that they can receive aggressive, risk-appropriate nutritional interventions, followed by multidisciplinary management of infections through resuscitative/antibiotic therapies.”

ReferenceLee DU, Fan GH, Hastie DJ, et al. The impact of malnutrition on the hospital and infectious outcomes of patients admitted with alcoholic hepatitis: 2011 to 2017 analysis of US hospitals. J Clin Gastroenterol. 2022;56(4):349-359. doi:10.1097/MCG.0000000000001528