Outcomes Among Hospitalized Patients with Heparin-Induced Thrombocytopenia with Concurrent Protein Energy Malnutrition: A United States Collaborative Network Cohort Study
Authors: Jones Colton Frisco , Obomanu Elvis , Byfield Karecia , Arya Yajur , Syal Arshi , Ramkissoon Avinash , Ugwe Chidiebube , Neely Ariana , Lewis Danielle , Mayo Ryan J 
Published: December 2024

Background
Heparin-induced thrombocytopenia (HIT) is a severe thrombotic complication caused by platelet activation via anti-PF4/heparin antibodies. HIT can be characterized by thrombocytopenia with thrombosis (HITT) or without thrombosis (isolated HIT) in a minority of patients after exposure to therapeutic doses of low molecular weight heparin or, more commonly, unfractionated heparin. HIT can lead to vascular thrombosis and is associated with increased morbidity and mortality. The impact of protein-energy malnutrition (PEM) on HIT outcomes has not been well-studied. This study aims to describe the adverse outcomes in patients with HIT and concurrent PEM.
Methods
Data from the United States Collaborative Network-TriNetX was used to assess the impact of protein-energy malnutrition (PEM) on patients hospitalized for heparin-induced thrombocytopenia (HIT). Our study population included patients with HIT, defined based on the International Classification of Disease, 10th Revision (ICD-10) code (D75.82). The primary exposure was PEM (defined based on the ICD-10 code E 46). Patients with HIT were divided into two cohorts: those with and without PEM. Using propensity score matching, HIT patients with PEM were matched with controls based on age, ethnicity, gender, and other comorbidities. Outcomes were tracked for 30 days post-hospitalization, focusing on all-cause mortality, need for transfusion, bleeding risk, intensive care unit (ICU) admission, risk of myocardial infarction (MI), and risk of pulmonary embolism (PE). A log-bimodal regression was used to measure the association of PEM and the outcomes of interest. Estimates were presented as risk ratios and 95% confidence intervals. A p-value of &lt;0.05 was considered statistically significant.
Results
Each cohort consisted of 3,007 patients with similar characteristics after propensity score matching. The PEM cohort's mean age was 68 years (SD +/- 15.9); 50.8% were males, and 63.3% were white. Patients with HIT and concurrent PEM had a statistically significant higher risk of all-cause mortality (RR: 1.17, 95% CI: 1.03-1.32), need for transfusion (RR: 1.81, 95% CI: 1.55-2.11), bleeding (RR: 1.31, 95% CI: 1.08-1.59), and ICU admission (RR: 1.44, 95% CI: 1.33-1.53). There was no statistically significant increase in the risk of MI (RR: 1.154, 95% CI 0.968-1.376) or PE (RR: 0.933, 95% CI 0.795-1.095).
Conclusion:
Our analysis showed that HIT patients with concurrent PEM had higher risks of all-cause mortality, transfusion need, ICU admission, and bleeding. Managing malnutrition in HIT patients is crucial to reducing complications and improving survival. Further prospective studies are needed to investigate the mechanisms underlying these associations and to assess specific interventions that could potentially alleviate these risks, ultimately enhancing patient care and prognosis.