Protein-Energy Malnutrition Increases Mortality in Patients Hospitalized With Bacterial Pneumonia: A Retrospective Nationwide Database Analysis

Gonakoti, Sriram; Osifo, Iyobosa F

Background Malnutrition is a less commonly recognized risk factor for various infections. It encompasses both undernutrition or protein-energy malnutrition (PEM) and overnutrition, including obesity. This study aimed to evaluate whether PEM impacts bacterial pneumonia (BP) and, if so, to quantify the degree of impact on inpatient outcomes. Methods This was a retrospective cohort study involving adult hospitalizations for BP using the nationwide inpatient database. Outcomes included comparing inpatient mortality, total hospital charges, length of hospital stay, as well as complications from bacterial pneumonia. Results The in-hospital mortality for adults with BP was 2.62%. Patients with PEM had a higher adjusted odds ratio (aOR) of inpatient mortality (adjusted odds ratio (aOR): 2.31, 95% confidence interval (CI): 2.14 - 2.48, p<0.001) as compared to non-PEM patients. PEM was also associated with higher odds of sepsis (aOR: 2.24, 95% CI: 2.04 - 2.46, p<0.001), septic shock (aOR: 3.29, 95% CI: 2.82 - 3.85, p<0.001), requiring mechanical ventilation (aOR: 2.51, 95% CI: 2.31 - 2.71, p<0.001), requiring vasopressors (aOR: 2.90, 95% CI: 2.20 - 3.83, p<0.001), acute respiratory distress syndrome (ARDS) (aOR: 1.63, 95% CI: 1.33 - 2.00, p<0.001), acute kidney failure (AKI) (aOR: 1.24, 95% CI: 1.18 - 1.29, p<0.001), deep vein thrombosis (DVT) (aOR: 1.80, 95% CI: 1.62 - 2.00, p<0.001), and pulmonary embolism (PE) (aOR: 1.25, 95% CI: 1.08 - 1.45, p=0.003). Conclusion The study concluded that PEM was an independent mortality predictor for those with BP, with an increased risk of systemic complications, as well as increased healthcare utilization costs.