Background: Heart failure (HF) is highly prevalent, whereas malnutrition is generally associated with poorer hospital outcomes, and it is not uncommon in patients with HF. Prior studies of the effect of malnutrition on HF outcomes are limited in size and quality. This study aims to elucidate the association between malnutrition and hospital length of stay (LOS), mortality, and discharge destination in patients with HF.Methods: This is a retrospective review of medical records for inpatients admitted with a primary diagnosis of HF in 2018. Patients with HF and severe proteincalorie malnutrition were compared with those without malnutrition. A twosided t-test was conducted between patients who have HF with and without malnutrition on hospital outcomes. Multivariate logistic regression was developed to identify potential predictors of malnutrition. A propensity score was calculated for each patient and matched cases (malnutrition with nonmalnutrition) to balance covariates and reduce bias. Results: For N = 7079, the median age was 75 years, with 15.79% having severe malnutrition. Overall mortality was 5.57% (394 deceased) . There were significant associations between malnutrition and both mortality (relative risk, 2.22; P < 0.001) and LOS (10 vs 5 days, P < 0.001) in patients with HF. Significantly fewer patients with malnutrition were discharged home (odds ratio, 0.41; P < 0.001). Conclusion: Patients with HF and malnutrition have higher risk for mortality, increased LOS in the hospital, and decreased chance of being discharged home. Continued study of this population is required to better predict which patients with malnutrition will respond to nutrition interventions.
We describe the case of a patient with extranodal marginal zone mucosa-associated lymphoid tissue (MALT) lymphoma of the gallbladder discovered incidentally after elective cholecystectomy. A 76-year-old female with a history of non-Hodgkin's lymphoma of the right breast and rectal cancer stage Tis requiring transanal excision presented with chronic intermittent abdominal pain. Computed tomography (CT) scan showed multiple calcified gallstones impacted in the gallbladder, with no evidence of enlarging lymphadenopathy indicating an elective cholecystectomy. The intra-and post-operative courses were unremarkable, but pathology review revealed immunohistochemistry positive for CD20 and BCL-2 with a Ki67 proliferation index of 5%, which was diagnostic of extranodal marginal zone MALT lymphoma of the gallbladder. The patient was followed up by a medical oncologist, and after extensive discussion, the decision was made to continue observation with close monitoring without systemic chemotherapy given the asymptomatic presentation. We also examined the pertinent literature to MALT lymphoma of the gallbladder and discussed theories suggested for its pathophysiology.
Objectives There is currently no model to predict the need for long-term tube-feeding. A predictive model may reduce unnecessary feeding tube placement. This study is a pilot effort toward developing a model to predict whether patients need tube feeding on hospital discharge. Methods All adult patients with tube feeding orders at any time during their hospitalization at the New York Presbyterian, Milstein Hospital during the period January 1st, 2018 to December 31st,2018 were evaluated. A student t-test was performed on the difference in average age between the subjects receiving tube feeding at discharge and the subjects discharged without tube feeding. Results The mean age of the subjects requiring tube feeding at discharge (66.2 ± 18 years) is 2.6 years higher than that in the group without tube feeding at discharge (63.6 + 17.2 years, P = 0. 0014). The distribution of age in both groups is left-skewed. The age of the subjects requiring tube feeding at discharge is fairly more dispersed compared the age of subjects without tube feeding at discharge. Conclusions We found that age is significantly higher in subjects requiring tube feeding at discharge. The actual difference in age is small, and its contribution to predicting tube feeding is unknown. The next step toward building a predictive model will be to apply appropriate regression analysis to assess the predictive value of 10 preliminarily identified to determine how and whether they predict which subjects need tube feeding at discharge. These are age, sex, insurance status, race, smoking status, BMI, head or neck cancer, tracheotomy, stroke severity, and dysphasia severity. Funding Sources None.
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