Shaikh Amjad, Khrais Ayham, Le Alexander, Ahlawat Sushil
Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA.
Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, USA.
Cureus. 2022 Jul 18;14(7):e26973. doi: 10.7759/cureus.26973. eCollection 2022 Jul.
Introduction Studies show that malnutrition can lead to worsening morbidity and mortality in patients. However, to our knowledge, no large database study has been conducted describing the effects of malnutrition in patients with diverticulitis. In this article, we aim to assess the impact of pre-existing malnutrition on outcomes of patients admitted for diverticulitis. Methods Data between 2008 and 2014 from the Nationwide Inpatient Sample database were extracted. Inclusion criteria for both groups included patients with a primary diagnosis of diverticulitis using the International Classification of Diseases, Ninth Revision codes. Exclusion criteria included all patients less than 18 years of age. The test group consisted of patients with a primary diagnosis of diverticulitis and a concurrent diagnosis of malnutrition. In-hospital mortality, length of stay, total cost, and complications, including various forms of sepsis, perforation, bleeding, and GI bleeding, were compared between the two groups. Univariate and multivariate analyses were used to generate odds ratios. Multivariate analysis included age, sex, race, income quartile, and calculated Elixhauser scores. Elixhauser comorbidity scores predicting mortality and readmission were calculated based on weighted scores from 29 different comorbidities. Scores were compared between the two groups using univariate analysis. Results There were a total of 1,520,919 patients in the study, of which 427,679 (2.8%) had a pre-existing diagnosis of malnutrition. On univariate analysis, there was a significant increase in mortality in patients with malnutrition (OR: 10.2, p < 0.01). Additionally, patients with malnutrition appeared to have longer lengths of stay (mean: 12.9, p < 0.01) and greater cost of hospitalization (mean: 194436.82, p < 0.01). Patients with malnutrition had greater rates of sepsis events (OR: 12.0, p < 0.01), perforation (OR: 2.8, p < 0.01), and GI bleed (OR: 1.84, p < 0.01). On multivariate analysis, malnutrition appeared to significantly increase mortality (OR: 3.3, p < 0.01). Discussion Patients who present with diverticulitis with malnutrition appear to have significantly worse outcomes. We hypothesize that malnutrition leads to a shift in the gut microbiota, resulting in increased inflammation. As a result, these patients may have an increased risk of worse outcomes, such as sepsis and death. Addressing nutrition in patients with diverticulosis or those with a history of diverticulitis may improve outcomes. This abstract was previously presented at the Digestive Disease Week Conference on May 22, 2022. Abstracts accepted at the conference were published in supplements of the journals Gastroenterology and GIE: Gastrointestinal Endoscopy.
引言 研究表明，营养不良会导致患者的发病率和死亡率恶化。然而，据我们所知，尚未有大型数据库研究描述营养不良对憩室炎患者的影响。在本文中，我们旨在评估既往存在的营养不良对因憩室炎入院患者预后的影响。
方法 提取2008年至2014年全国住院患者样本数据库中的数据。两组的纳入标准均包括使用国际疾病分类第九版编码进行憩室炎初步诊断的患者。排除标准包括所有年龄小于18岁的患者。试验组由憩室炎初步诊断且同时诊断为营养不良的患者组成。比较两组患者的住院死亡率、住院时间、总费用以及并发症，包括各种形式的败血症、穿孔、出血和胃肠道出血。采用单因素和多因素分析生成比值比。多因素分析包括年龄、性别、种族、收入四分位数和计算的埃利克斯豪泽评分。基于29种不同合并症的加权评分计算预测死亡率和再入院率的埃利克斯豪泽合并症评分。使用单因素分析比较两组评分。
结果 本研究共有1,520,919例患者，其中427,679例（2.8%）既往诊断为营养不良。单因素分析显示，营养不良患者的死亡率显著增加（比值比：10.2，p<0.01）。此外，营养不良患者的住院时间似乎更长（平均：12.9天，p<0.01），住院费用更高（平均：194436.82美元，p<0.01）。营养不良患者的败血症事件发生率更高（比值比：12.0，p<0.01）、穿孔发生率更高（比值比：2.8，p<0.01）以及胃肠道出血发生率更高（比值比：1.84，p<0.01）。多因素分析显示，营养不良似乎显著增加死亡率（比值比：3.3，p<0.01）。
讨论 患有憩室炎且伴有营养不良的患者预后似乎明显更差。我们推测，营养不良会导致肠道微生物群发生变化，从而导致炎症增加。因此，这些患者出现败血症和死亡等更差预后的风险可能会增加。解决憩室病患者或有憩室炎病史患者的营养问题可能会改善预后。本摘要先前于2022年5月22日在消化疾病周会议上发表。该会议接受的摘要发表在《胃肠病学》和《GIE：胃肠内镜》杂志的增刊上。
