Micronutrient deficiencies likely underdiagnosed in dermatologic inpatients

Patients hospitalized for dermatologic issues with concomitant micronutrient deficiencies had a significantly increased length of stay and higher 30-day mortality rates, according to a study.

“Micronutrient deficiencies are likely underdiagnosed, and given the differences in outcomes, increased awareness and testing should be considered in dermatologic inpatients,” John Trinidad, MD, MPH, of the department of internal medicine and division of dermatology at the Ohio State University Wexner Medical Center, and colleagues wrote.

Researchers evaluated the effect of micronutrient deficiencies with cutaneous findings on hospitalized patient outcomes using a matched case-control study. Included patients were admitted to the medical center or ancillary hospitals of the center from 2011 to 2017 and received an ICD-9/10 coded skin disease during hospitalization.

Overall, 1,023 patients were identified with micronutrient deficiencies of vitamins A, B3, B6, C, copper and zinc or corresponding named syndromes. Within 1 year of discharge, patients were validated by laboratory evidence for micronutrient deficiency.

Among 65 patients, researchers found 90 cases of micronutrient deficiencies of vitamin A (n = 9), B3 (n = 7), B6 (n = 8), C (n = 10) and zinc deficiency (n = 46).

Eighteen patients had evidence of more than one micronutrient deficiency. A total of 89 controls were matched by age, sex and comorbidity index.

BMI differed significantly between cases and was higher in control patients at 34.1 kg/m² vs. dermatologic cases at 27.7 kg/m².

Dermatologic cases with micronutrients deficiencies had a longer length of stay at 21 days compared with 8.3 days for controls (P < .0001). Thirty-day mortality rates were also higher at 23.3% in dermatologic cases vs. 7.9% for controls (P < .05). There were also more inpatient dermatology consults in 98.9% of cases compared with 40.4% of controls (P < .001).

The hospitalized dermatology patients may have had more prominent skin disease, according to the study.

From 2012 and 2017, researchers reported a modest increase in dermatology consult volume of 142% while diagnosis of micronutrient deficiencies tripled at 320%.

“Anecdotally we attribute this to increased diagnostic awareness and value in dedicated dermatologic inpatient consultation services established in 2014,” Trinidad and colleagues wrote.

The researchers found various micronutrient deficiencies in hospitalized dermatology patients, which may lead to poor outcomes like substantially increased length of stay and mortality rates. – by Abigail Sutton

Disclosures: Trinidad reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.