S2862 Impact of Malnutrition on Clinical Outcomes in Hepatocellular Carcinoma Patients With Gastrointestinal Bleeding: A Propensity Score-Matched Population-Based Cohort Study

Introduction: Malnutrition is a risk factor for adverse outcomes in a variety of clinical scenarios. This modifiable risk factor has the potential to significantly impact overall prognosis in patients with hepatocellular carcinoma. Our study aims to evaluate the impact of malnutrition on clinical outcomes in hepatocellular carcinoma (HCC) patients with concurrent gastrointestinal (GI) bleeding. Methods: We utilized data from the Global Collaborative Network TrinetX platform for statistical analysis and cohort identification. Participants aged 18 and older were identified using relevant International Classification of Diseases, Tenth Revision Clinical Modification codes. Cohorts were stratified into 2 groups: Cohort 1 comprised of patients with HCC, GI bleeding, and concomitant malnutrition. Cohort 2 was comprised of patients with HCC and GI bleeding but without malnutrition. Cohorts were propensity score matched based on demographics and comorbidities. The primary aim was to assess clinical outcomes including the incidence of sepsis, all-cause mortality, spontaneous bacterial peritonitis (SBP), need for transfusion, hepatic encephalopathy (HE), myocardial infarction, pulmonary embolism, and hepatorenal syndrome (HRS) over a 5-year period. Patients with outcomes before the study window were excluded from the analysis. Multivariate logistic regression analysis was used to measure the association, and estimates were presented as risk ratios with 95% confidence interval. Results: After propensity score matching, 4,923 participants were included in each cohort. In cohort 1, 69.1% were man, 60% were White, and the mean age was 69.7 years (SD ± 11.1). In cohort 2, 68.9% were man, 61% were White and the mean age was 69.7 years (SD ± 11.3). Participants admitted with malnutrition had a statistically significantly higher risk of sepsis (RR: 1.483, 95% CI: 1.324-1.661), all-cause mortality (RR: 1.165, 95% CI: 1.118-1.213), SBP (RR: 1.309, 95% CI: 1.080-1.587), need for transfusion (RR: 1.429, 95% CI: 1.260-1.621), HE (RR: 1.205, 95% CI: 1.076-1.350), myocardial infarction (RR: 1.305, 95% CI: 1.074-1.586), and HRS (RR: 1.549, 95% CI: 1.297-1.849) when compared to those without malnutrition. Conclusion: Malnutrition significantly increases mortality, risk of SBP and sepsis, HE, HRS, myocardial infarction, and need for transfusions in HCC patients with GI bleeding. This underscores the importance of comprehensive nutritional assessment and optimization of nutritional status in these patients.