S2786 Protein-Energy Malnutrition as an Independent Risk Factor for Mortality and Intervention Burden in Cirrhosis

Introduction: Cirrhotic patients are particularly vulnerable to protein-energy malnutrition (PEM) due to metabolic dysregulation and impaired nutrient absorption. Despite its clinical relevance, the impact of PEM on inpatient outcomes in this population remains underexplored at the national level. We aimed to assess how PEM influences mortality, hospital resource use, and procedural interventions among cirrhotic inpatients. Methods: We performed a retrospective cohort analysis using the 2022 National Inpatient Sample (NIS) database. Adult hospitalizations with cirrhosis and PEM were identified using validated International Classification of Diseases, Tenth Revision (ICD-10) codes. The primary outcome of this study was inpatient mortality. Secondary outcomes included length of stay (LOS), total hospital charges, and procedure utilization—specifically paracentesis, TIPS, colonoscopy, and endoscopy. Multivariable logistic regression was used to adjust for demographics, hospital characteristics, and relevant comorbidities. Analyses were conducted in STATA 18. Results: Of an estimated 851,260 cirrhotic hospitalizations, 125,410 (15%) had coexisting PEM. Patients with PEM had significantly worse outcomes, including higher mortality (11.0% vs 6.0%, P < 0.001), longer hospital stays (10.7 vs 6.0 days, P < 0.001), and greater hospitalization costs ($146,108 vs $82,826, P < 0.001). After adjustment, PEM remained independently associated with increased odds of in-hospital death (aOR 1.70, 95% CI 1.61–1.80, P < 0.001). Additionally, PEM was significantly associated with higher odds of undergoing paracentesis (aOR 2.04, 95% CI 1.97–2.11, P < 0.001), but showed no significant association with TIPS (aOR 1.03, P = 0.716), colonoscopy (aOR 2.24, P = 0.099), or endoscopy (aOR 2.92, P = 0.087). Conclusion: Protein-energy malnutrition is an independent predictor of adverse outcomes in hospitalized patients with cirrhosis. These patterns likely reflect both underlying disease severity and gaps in early nutritional intervention. Incorporating early, standardized nutritional assessment into inpatient cirrhosis care may offer a tangible strategy for reducing inpatient complications and resource utilization.