Effects of hyperglycemia on in-hospital outcomes on gastric and esophageal cancer patients suffering from cachexia: Insights from the National Inpatient Sample.

Abstract

e16089 Background: Cachexia is a debilitating syndrome commonly associated with gastric and esophageal cancer (GEC). Cancer patients may experience hyperglycemia as a result of underlying conditions or treatments. Insulin resistance is a common mechanism that links both cachexia and hyperglycemia. The purpose of this study is to compare the effects of hyperglycemia on outcomes of cachectic patients with GEC. Methods: The National Inpatient Sample (NIS) years 2016-2020 was used to identify all patients with esophageal and/or gastric cancer and cachexia. These patients were stratified into a no hyperglycemia and hyperglycemia cohort based on associated diagnoses determined by ICD-10 codes. Comorbidity burden was measured by the Charlson comorbidity index (CCI) also using appropriate ICD-10 codes. Demographic and clinical data were collected and analyzed using chi squared tests and independent sample t- tests. Adjusted Odds ratios (aOR) are presented with 95% Confidence intervals (CI). A p-value of less than 0.05 was deemed to be statistically significant. Results: A total of 30,920 hospitalizations of cachectic GEC patients were included, of which 1,240 had hyperglycemia. Hyperglycemic patients were older (66.71 vs 64.62, p < .001), and had higher comorbidity burden as measured by the CCI (9.9 vs 8.8, p < .001). Hyperglycemic hospitalizations had higher rates of malnutrition (72.2% vs 65.5%, p < .001), nutrition consults (2.0% vs 0.6%, p < .001), total parenteral nutrition (TPN) use (8.9% vs 7.1%, p = .019), and enteral tube placement (17.3% vs 13.6%, p < .001). Hyperglycemic hospitalizations had longer lengths of stay (10.6 days vs 8.8 days, p < .001), lower rates of palliative consult (30.9% vs 39.8%, p = .002). There was no significant difference in mortality between the groups. Conclusions: Hyperglycemia patients had higher rates of malnutrition, which consequently resulted in higher rates of nutrition consultation, TPN usage, and enteral feeding tube placements. However, despite being older and having higher comorbidity burden, these patients had lower rates of palliative care consultation. Addressing the interplay of insulin resistance between cachexia and hyperglycemia may have potential for improving outcomes in this patient population. However, quality improvement measures are required to ensure management of hyperglycemia does not overshadow other critical aspects of managing cancer patients. No HyperglycemiaN=29,680 HyperglycemiaN=1,240 p-value Age 64.62 ± 12.87 66.71 ± 13.21 <.001 CCI 8.8 ± 3.3 9.9 ± 3.4 <.001 LOS 8.1 ± 9.0 10.6 ± 12.1 <.001 Nutrition Consult 190 (0.6%) 25 (2.0%) <.001 Palliative Consult 12130 (39.8%) 835 (30.9%) .002 Total Parenteral Nutrition 2110 (7.1%) 110 (8.9%) .019 Gastrostomy/Jejunostomy Tube 4030 (13.6%) 215 (17.3%) <.001 Malnutrition 19435 (65.5%) 895 (72.2%) <.001 Mortality 5125 (17.3%) 210 (17.0%) .808