The impact of protein-energy malnutrition on outcomes in patients with cholangiocarcinoma admitted with sepsis: Insights from a national database.
Authors: Gebremedhen Adamsegd Isac , Wiese Jennifer , Shanti Ibrahim , Zeleke Sinen Tadesse , Roy Stephen , Kachynski Yury , Tirona Maria Tria 
Published: January 2025

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Background:
Patients with cholangiocarcinoma (CCA) are prone to infection and related complications. Protein-energy malnutrition (PEM) is common among these patients, arising from either the malignancy or its treatments. PEM is linked to worse medical and surgical outcomes and longer hospital stays across various cancers. The impact of PEM on CCA patients with sepsis, however, remains underexplored. This study aims to fill this gap by assessing how PEM affects in-hospital outcomes in CCA patients admitted with sepsis.
Methods:
We queried the Healthcare Cost and Utilization Project National Inpatient Sample and identified adult patients with CCA admitted with the principal diagnosis of sepsis from 2018 to 2021, using the ICD-10 code. We categorized the cohort based on the presence or absence of PEM and applied complex sampling weights for national representativeness. We compared socio-demographic characteristics and comorbidities between CCA patients with sepsis who have PEM and those who do not. The primary outcome studied was all-cause in-hospital mortality. Secondary outcomes examined were acute kidney injury (AKI), renal replacement therapy (RRT), respiratory failure (RF), invasive ventilation (IV), septic shock, vasopressor requirement (VP), mean length of hospital stay (LOS), and mean total hospitalization charges (THC). Multivariate regression models assessed outcome disparities between groups, adjusting for patient characteristics and comorbidities, with statistical significance set at p < 0.05.
Results:
We identified a total of 22,680 adults with CCA who were admitted with the principal diagnosis of sepsis from 2018 to 2021. Among these, 7,245 patients (31.9%) had a concurrent diagnosis of PEM. The PEM group had a higher proportion of female (47.3% vs 44.1%, p=0.04) and non-white (41.7% vs 37.2%, p<0.001) patients and patients with Charlson Comorbidity Index > 3 (86.5% vs 83.3%, p<0.001). Patients with PEM had higher odds of all-cause in-hospital mortality with an adjusted odds ratio (aOR) of 1.26 (95% confidence interval (CI) 1.05-1.51). They also had higher odds of AKI with an aOR of 1.32 (95% CI 1.16-1.50), RF with an aOR of 1.30 (95% CI 1.09-1.51), and septic shock with an aOR of 1.22 (95% CI 1.06-1.40). Patients with PEM also had a higher LOS (9.0 vs 6.3 days) with an adjusted incidence rate ratio (aIRR) of 1.41 (95% CI 1.33-1.49) and THC ($115,971 vs $83,176) with aIRR of 1.35 (95% CI 1.25-1.45).
Conclusions:
Our study revealed that CCA patients with PEM admitted with sepsis had significantly higher odds of in-hospital mortality, AKI, RF, and septic shock compared to those without PEM. They also experienced longer hospital stays and higher hospitalization charges. These findings highlight the urgent need to address PEM in CCA patients and tailor inpatient management to reduce complications in this high-risk group.