Protein-Energy Malnutrition Increases the Risk of Death in Patients With DLBCL Undergoing Chemotherapy

In patients with diffuse large B-cell lymphoma (DLBCL) who receive chemotherapy, protein-energy malnutrition (PEM) is associated with a 4-fold increase in the odds of death, according to a new study presented at the 2022 American Society of Clinical Oncology Annual Meeting.

To remedy the paucity of data on the effects of PEM on outcomes in patients receiving chemotherapy for DLBCL, the researchers conducted a retrospective cohort study by using data from the 2016-2018 combined National Inpatient Sample database. The cohort included 76,425 adult patients who had been admitted to the hospital for chemotherapy for a principal diagnosis of DLBCL and who were identified using the 10th revision of the International Diseases Classification code. Patients were stratified into 2 cohorts based on whether they had a secondary diagnosis of PEM.

The study’s primary outcomes were mortality, length of stay, and total charges for hospitalization. Its secondary outcomes were neutropenia, urinary tract infection, septic shock, bacteremia, candida sepsis, acute kidney injury, acute liver failure, and acute respiratory failure. The researchers used multivariate linear and logistic regressions to adjust for confounding variables.

As a result, they determined that 2.3% of study patients had a secondary diagnosis of PEM, which was associated with increased odds of mortality (adjusted odds ratio, 12.7; 95% CI, 6.3-25.4, P < .001). Moreover, patients with PEM had a longer length of stay than those without PEM (7.6 vs 5 days; adjusted difference, 2.7 days; 95% CI, 1.9-3.6, P < .001) as well as greater total charges ($97,500 vs $60,600; adjusted difference, $37,109; 95% CI, $20,140-$54,080, P < .001).

In addition, PEM was associated with greater odds of neutropenia, septic shock, bacteremia, candida sepsis, acute kidney injury, and acute respiratory failure, but no difference was found between groups in the odds of urinary tract infection or acute liver failure.

“Prospective trials to evaluate PEM as an independent prognostic marker of chemotherapy tolerance and adequate nutritional support can improve clinical outcomes,” the researchers concluded.


—Ellen Kurek


Deenadayalan V, Danso Kumi D, Shah M, et al. Impact of protein-energy malnutrition on outcomes among patients with diffuse large B cell lymphoma admitted for inpatient chemotherapy. Abstract e19539 presented at: 2022 American Society of Clinical Oncology Annual Meeting; June 3-7, 2022; Chicago, IL.  doi:10.1200/JCO.2022.40.16_suppl.e19539