Abstract
Patients with sickle cell disease (SCD) are often malnourished, leading to complications such as increased vaso-occlusive crises, infections, prolonged hospital stays, and decreased quality of life. This study examines the impact of protein-energy malnutrition (PEM) on clinical outcomes in hospitalized SCD patients. A retrospective cohort study using National Inpatient Sample data (2016-2020) was performed. Adult SCD patients were stratified by PEM status. Primary outcomes included mortality, length of stay, and hospital charges. Multivariate regression analyses were performed in STATA 17. Among 771,175 SCD patients, 25.9% (20,030) had PEM. More PEM patients were female (57.3%), and PEM was more prevalent in males compared to those without (42.7% vs. 34.3%, p < 0.001). Patients with PEM had higher Charlson Comorbidity Index scores (≥ 3: 42.6% vs. 12.8%, p < 0.001). PEM was associated with increased mortality (aOR 2.66, p < 0.001), longer hospital stays (9.56 vs. 4.79 days, p < 0.001), and higher costs ($100,209 vs. $41,412, p < 0.001). PEM also raised the odds of intubation, pressor support, acute kidney injury, sepsis, blood transfusion, pneumonia, and urinary tract infections (all p < 0.001). PEM is associated with worse outcomes in hospitalized SCD patients, leading to higher mortality, extended stays, and increased costs due to intensive interventions. Early nutritional consultation may improve patient outcomes.