TY - JOUR
T1 - Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein-Energy Malnutrition
AU - Adejumo, Adeyinka Charles
AU - Adejumo, Kelechi Lauretta
AU - Adegbala, Oluwole Muyiwa
AU - Enwerem, Ngozi
AU - Ofosu, Andrew
AU - Akanbi, Olalekan
AU - Fijabi, Daniel Obadare
AU - Ogundipe, Olumuyiwa Akinbolaji
AU - Pani, Lydie
AU - Adeboye, Adedayo
N1 - Publisher Copyright:
© 2019 American Society for Parenteral and Enteral Nutrition
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Background: Protein-energy malnutrition (PEM) diminishes amino acid and energy availability, impairing the body's healing capability after injury, such as in myocardial damage following acute myocardial infarction (AMI). Aims: We sought to investigate the influence of PEM on clinical outcomes of AMI. Methods: We identified records with a primary discharge diagnosis of AMI from the Nationwide Inpatient Sample (2012–2014), stratified by concomitant PEM. We matched PEM to no-PEM (1:1) using a greedy algorithm–based propensity methodology and estimated the impact of PEM on health outcomes (SAS 9.4). Results: Of the 332,644 hospitalizations for AMI, 11,675 had concomitant PEM accounting for roughly $US 1.5 billion and over 119,792 hospital days. PEM was associated with older age (74.43- vs. 66.90-years; P < 0.0001), female sex (49.19% vs. 38.44%; P < 0.0001), black race (12.78% vs. 10.46%; P < 0.0001), and higher comorbidity burden (Deyo > 3: 32.77% vs. 16.69%; P < 0.0001). After propensity matching, PEM was associated with higher mortality (Adjusted odds ratio [AOR]: 1.59 [1.46–1.73]), cardiogenic shock (AOR: 2.26 [2.08–2.44]), discharge to secondary facilities (AOR: 2.21 [2.10–2.33]), charges ($135,500 [$131,956–139,139] vs. $81,084 [$79,241–82,970]), cardiac artery bypass surgery (AOR:1.81 [1.66–1.97]), intra-aortic balloon pump placement (AOR: 1.83 [1.65–2.04]) and longer length of stay (10.15- vs. 5.52-days). Conclusions: PEM is a predisposing factor for devastating clinical outcomes among AMI hospitalizations. Higher prevention, identification and management of PEM among high-risk individuals (older age, female sex, and black race) residing in the community are needed.
AB - Background: Protein-energy malnutrition (PEM) diminishes amino acid and energy availability, impairing the body's healing capability after injury, such as in myocardial damage following acute myocardial infarction (AMI). Aims: We sought to investigate the influence of PEM on clinical outcomes of AMI. Methods: We identified records with a primary discharge diagnosis of AMI from the Nationwide Inpatient Sample (2012–2014), stratified by concomitant PEM. We matched PEM to no-PEM (1:1) using a greedy algorithm–based propensity methodology and estimated the impact of PEM on health outcomes (SAS 9.4). Results: Of the 332,644 hospitalizations for AMI, 11,675 had concomitant PEM accounting for roughly $US 1.5 billion and over 119,792 hospital days. PEM was associated with older age (74.43- vs. 66.90-years; P < 0.0001), female sex (49.19% vs. 38.44%; P < 0.0001), black race (12.78% vs. 10.46%; P < 0.0001), and higher comorbidity burden (Deyo > 3: 32.77% vs. 16.69%; P < 0.0001). After propensity matching, PEM was associated with higher mortality (Adjusted odds ratio [AOR]: 1.59 [1.46–1.73]), cardiogenic shock (AOR: 2.26 [2.08–2.44]), discharge to secondary facilities (AOR: 2.21 [2.10–2.33]), charges ($135,500 [$131,956–139,139] vs. $81,084 [$79,241–82,970]), cardiac artery bypass surgery (AOR:1.81 [1.66–1.97]), intra-aortic balloon pump placement (AOR: 1.83 [1.65–2.04]) and longer length of stay (10.15- vs. 5.52-days). Conclusions: PEM is a predisposing factor for devastating clinical outcomes among AMI hospitalizations. Higher prevention, identification and management of PEM among high-risk individuals (older age, female sex, and black race) residing in the community are needed.
KW - charges
KW - discharge disposition
KW - length of stay
KW - mortality
KW - shock
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U2 - 10.1002/jpen.1680
DO - 10.1002/jpen.1680
M3 - Article
C2 - 31317574
AN - SCOPUS:85069813652
SN - 0148-6071
VL - 44
SP - 454
EP - 462
JO - Journal of Parenteral and Enteral Nutrition
JF - Journal of Parenteral and Enteral Nutrition
IS - 3
ER -