Malnutrition linked with increased mortality, infections in alcoholic hepatitis

Malnutrition correlated with increased hospital mortality and infections in patients with alcoholic hepatitis, according to a presenter at The Liver Meeting Digital Experience.

“This suggests there is a malnutrition-induced immune dysfunction that globally affect all infectious outcomes in patients with alcoholic hepatitis,” David U. Lee, MD, from the department of gastroenterology and hepatology at Tufts Medical Center, said during his presentation.

Lee and colleagues identified 89,315 patients with alcoholic hepatitis from the 2011-2017 National Inpatient Sample; 10,132 of whom had malnutrition. Investigators compared patients with malnutrition with non-malnutrition patients, analyzing mortality, length of hospital stay, hospitalization costs and infection outcomes. To control for potential confounding variables, researchers performed multivariate analyses.

Investigators reported patients in the malnutrition group were older (50.8 vs. 47.2 years; P < .01) and comprised more women (39.5% vs. 30%; P < .01). The malnutrition group also had a higher rate of mortality (5.03% vs. 1.88%; OR = 2.77; 95% CI, 2.5-3.07), length of hospital stay (9.18 vs. 5.01 days; P < .01) and hospitalization costs ($74,156 vs. $38,127; P < .01). Further, the malnutrition group had higher incidences of sepsis, pneumonia, cellulitis, cholangitis and Clostridioides difficle infection.

Results from a series of multivariate models showed that malnutrition correlated with increased hospital mortality ([adjusted] OR = 1.35; 95% CI 1.2-1.52) and infectious outcomes such as sepsis(aOR = 2.24; 95% CI, 2.09-2.41), pneumonia (aOR = 1.41; 95% CI, 1.24-1.6), urinary tract infection (aOR = 1.57; 95% CI, 1.47-1.68), cellulitis (aOR = 1.41; 95% CI, 1.24-1.6), cholangitis (aOR = 1.71; 95% CI, 1.13-2.53), C. difficile infection (aOR = 2.05; 95% CI, 1.71-2.45), despite controlling for age, sex, race, common comorbidities, cirrhosis etiologies, and hepatic events.

“To precisely delineate the role of malnutrition and its impact on immune deficits, further molecular/prospective studies are required in this specific cohort of patients with alcoholic hepatitis and malnutrition,” Lee said.