Epidemiology, clinical outcomes, and healthcare resource utilization in non-Hodgkin’s lymphoma patients with protein-energy malnutrition hospitalized for acute congestive heart failure: A comprehensive population-based study.

Abstract

e19053 Background: Patients with non-Hodgkin's lymphoma (NHL) are at heightened risk of heart failure due to the cardiotoxic effects of chemotherapy, especially anthracyclines, combined with pre-existing cardiovascular risk factors. Protein-energy malnutrition (PEM) is common among hospitalized lymphoma patients and is associated with increased mortality. However, its specific impact on outcomes in NHL patients with acute congestive heart failure (ACHF) remains unclear. This study explores how PEM influences in-hospital outcomes in NHL patients with ACHF. Methods: We identified adult NHL patients from the National Inpatient Sample admitted with ACHF as the principal diagnosis between 2018 and 2021 using ICD-10 codes. The cohort was divided based on the presence or absence of PEM, with complex sampling weights applied for national representativeness. The primary outcome was all-cause mortality; several secondary outcomes were also analyzed. Multivariate regression models assessed outcome disparities between groups, with statistical significance set at p < 0.05. Results: We identified 2,845 adults with NHL admitted with ACHF from 2018 to 2021, of whom 420 patients (14.8%) had a concurrent PEM. There were no significant demographic differences between patients with and without PEM. The overall mortality rate was 4.7%, compared to 10.7% in the PEM group. Patients with PEM had higher odds of experiencing cardiogenic shock [aOR 3.0, 95% CI 1.2–7.3], requiring mechanical ventilation [aOR 3.5, 95% CI 1.1–11.9], and needing renal replacement therapy [aOR 19.4, 95% CI 1.7–218.8]. However, the PEM group did not show increased odds of all-cause mortality, acute kidney injury, or respiratory failure compared to those without PEM. Additionally, the groups did not differ significantly in the use of vasopressors, intra-aortic balloon pumps, left ventricular assist devices, or extracorporeal membrane oxygenation. Patients with PEM had longer hospital stays (10.0 vs. 5.5 days, p < 0.001; adjusted incidence rate ratio [aIRR] 1.6, 95% CI 1.3–2.1) and higher hospitalization charges ($137,018 vs. $59,141, p < 0.05; [aIRR] 1.9, 95% CI 1.3–2.7). Conclusions: Although NHL patients with PEM admitted with ACHF did not experience increased odds of all-cause mortality, they still faced increased odds of cardiogenic shock and a greater need for intensive care. These patients also experienced longer hospital stays and incurred higher hospitalization charges. These findings underscore the importance of addressing the long-term nutritional needs of NHL patients, to mitigate in-hospital complications and improve outcomes.