Influence of nutritional anemia on outcomes of colorectal cancer hospitalizations: a national inpatient sample database study

Madhav Changela; Sagar Pandey; Janak Bahirwani; Nishit Patel; Maulik Kaneriya; Mihir Shah; Sanket Basida; Kapilkumar Manvar; Samaj Adhikari; Kalpana Panigrahi

doi:10.18203/2320-6012.ijrms20243680

Authors

Madhav Changela Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States
Sagar Pandey Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States
Janak Bahirwani Department of Gastroenterology, Kadlec Regional Medical Center, Richland, Washington, United States
Nishit Patel Department of Gastroenterology, St Luke’s University Health Network, Bethlehem, Pennsylvania, United States
Maulik Kaneriya Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States
Mihir Shah Department of Internal Medicine, OU Health University of Oklahoma Medical Center, Oklahoma City, Oklahoma, United States
Sanket Basida Department of Internal Medicine, University of Missouri, Columbia, Missouri, United States
Kapilkumar Manvar Florida Cancer Specialists & Research Institute, 750 Orienta Ave, Altamonte Springs, Florida, United States
Samaj Adhikari Department of Internal Medicine, Decatur Memorial Hospital, Decatur, Illinois, United States
Kalpana Panigrahi Department of Internal Medicine, One Brooklyn Health System/Interfaith Medical Center, Brooklyn, New York, United States

DOI:

https://doi.org/10.18203/2320-6012.ijrms20243680

Keywords:

Colorectal cancer, Mortality, Nutritional anemia

Abstract

Background: Colorectal carcinoma (CRC) is one of the leading causes of cancer related death globally. Prevalence of Nutritional Anemia is high among CRC patients. We aim to evaluate the role of Nutritional anemia on outcomes of CRC hospitalization.

Methods: We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) database, including all adult CRC patients hospitalized in the United States from 2016 to 2019. Patients were stratified into those with and without nutritional anemia (16.19% vs 83.81%) which included iron, B12, folate deficiency and other nutritional anemia per ICD-10 coding. Mortality was the primary outcome whereas length of stay (LOS), total charges, acute kidney injury (AKI), pulmonary embolism (PE), deep vein thrombosis (DVT), colonoscopy, abdominal surgery and lower gastrointestinal (GI) bleeding were secondary outcomes. Multivariate regression model was used to estimate the outcomes of CRC hospitalization after adjusting for potential confounders.

Results: A total of 504,515 patients were hospitalized for CRC. Among two groups, patients with anemia were older in age. Mortality was significantly lower among patients with nutritional anemia. Lower GI bleeding and colonoscopy during inpatient stay were significantly higher among CRC cohort with nutritional anemia. Similarly, LOS, total hospitalization charges, AKI, PE and DVT were also significantly higher among anemia cohort. However, need for abdominal surgery was significantly lower among CRC patients with nutritional anemia.

Conclusions: Nutritional anemia in CRC patients is associated with longer length of stay, increased cost, higher risk of in-patient complications. Therefore, it should be corrected to optimize outcomes among CRC patients.

Metrics

Metrics Loading ...

References

CDC. U.S. Cancer Statistics Data Visualizations Tool., 2023. Available at: https://www.cdc.gov/cancer/uscs/dataviz/index.htm. Accessed 01 May 2024.

Tan JY, Yeo Y-H, Ng WL, Fong ZV, Brady JT. How have US colorectal cancer mortality trends changed in the past 20 years? Int J Cancer. 2024;155(3):493-500.

Damle RN, Alavi K. Risk factors for 30-d readmission after colorectal surgery: a systematic review. J Surg Res. 2016;200(1):200-7.

Wilson MJ, Dekker JWT, Harlaar JJ, Jeekel J, Schipperus M, Zwaginga JJ. The role of preoperative iron deficiency in colorectal cancer patients: prevalence and treatment. Int J Colorectal Dis. 2017;32:1617-24.

Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352(10):1011-23.

Ward DG, Roberts K, Brookes MJ, Joy H, Martin A, Ismail T, et al. Increased hepcidin expression in colorectal carcinogenesis. World J Gastroenterol. 2008;14(9):1339-45.

Pasricha S-R, Tye-Din J, Muckenthaler MU, Swinkels DW. Iron deficiency. The Lancet. 2021;397(10270):233-48.

Chardalias L, Papaconstantinou I, Gklavas A, Politou M, Theodosopoulos T. Iron deficiency anemia in colorectal cancer patients: is preoperative intravenous iron infusion indicated? a narrative review of the literature. Cancer Diagn Progn. 2023;3(2):163-8.

Douaiher J, Ravipati A, Grams B, Chowdhury S, Alatise O, Are C. Colorectal cancer-global burden, trends, and geographical variations. J Surg Oncol. 2017;115(5):619-30.

Shrubsole MJ, Yang G, Gao YT, Chow WH, Shu XO, Cai Q, et al. Dietary B vitamin and methionine intakes and plasma folate are not associated with colorectal cancer risk in chinese women. Can Epidemiolo Biomark Prevent. 2009;18(3):1003-6.

Giovannucci E, Stampfer MJ, Colditz GA, Rimm EB, Trichopoulos D, Rosner BA, et al. Folate, methionine, and alcohol intake and risk of colorectal adenoma. J Natl Cancer Inst. 1993;85(11):875-84.

Agency for Healthcare Research and Quality. HCUP-US NIS Overview. Available at: https://hcup-us.ahrq.gov/nisoverview.jsp. Accessed 01 May 2024.

Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project (HCUP). Available at: https://www.ahrq.gov/data/hcup/index.html. Accessed 01 May 2024.

Ng AP, Cho NY, Kim S, Ali K, Mallick S, Lee H, Benharash P. National analysis of racial disparities in emergent surgery for colorectal cancer. Surg Open Sci. 2024;18:35-41.

Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-9.

Olafimihan A, Jackson I, Ozogbo S, Bello J, Fawehinmi P, Shaka H, et al. EPR24-107: Disparities in Colorectal Cancer Mortality Outcomes: A Ten-Year Trend Study. J Nat Compre Cancer Netw. 2024;22(2.5).

Mörner MEM, Edgren G, Martling A, Gunnarsson U, Egenvall M. Preoperative anaemia and perioperative red blood cell transfusion as prognostic factors for recurrence and mortality in colorectal cancer-a Swedish cohort study. Int J Colorectal Dis. 2017;32:223-32.

Baratam P, Correa E, Perimbeti S, Styler M, Topolsky D, Crilley PA, et al. Impact of iron deficiency anemia on inpatient mortality, hospital cost, and length of stay in patients with luminal gastrointestinal cancers: data from the healthcare cost and utilization project from 1999-2014. Blood. 2017;130:4669.

Liu H, Song B, Jin J, Liu Y, Wen X, Cheng S, et al. Length of stay, hospital costs and mortality associated with comorbidity according to the charlson comorbidity index in immobile patients after ischemic stroke in china: a national study. Int J Health Policy Manag. 2022;11(9):1780-7.

Bahrmann A, Benner L, Christ M, Bertsch T, Sieber CC, Katus H, et al. The Charlson Comorbidity and Barthel Index predict length of hospital stay, mortality, cardiovascular mortality and rehospitalization in unselected older patients admitted to the emergency department. Aging Clin Exp Res. 2019;31:1233-42.

Zhang X, Wang X, Wang M, Gu J, Guo H, Yang Y, et al. Effect of comorbidity assessed by the Charlson Comorbidity Index on the length of stay, costs, and mortality among colorectal cancer patients undergoing colorectal surgery. Curr Medi Res Opin. 2023;39(2):187-95.

Niu C, Zhang J, Lian J, Utsav J, Iyer C, Low S, et al. Anatomical location, risk factors, and outcomes of lower gastrointestinal bleeding in colorectal cancer patients: a national inpatient sample analysis (2009–2019). Inter J olorec Dis. 2023;38:205.

Dekker E, Tanis PJ, Vleugels JLA, Kasi PM, Wallace MB. Colorectal cancer. The Lancet. 2019;394(10207):1467-80.

Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. ACG. 2016;111(4):459-74.

Lasson A, Kilander A, Stotzer PO. Diagnostic yield of colonoscopy based on symptoms. Scandi J Gastroenterol. 2008;43(3):356-62.

Sergueeva A, Miasnikova G, Shah BN, Song J, Lisina E, Okhotin DJ, et al. Prospective study of thrombosis and thrombospondin-1 expression in Chuvash polycythemia. Haematol. 2017;102:e166-9.

Franchini M, Targher G, Montagnana M, Lippi G. Iron and thrombosis. Ann Hematol. 2008;87:167.

Can C, Topacoglu H, Ucku R. Investigation of relationship between blood hemoglobin level and acute pulmonary embolism in emergency setting. Int Med J. 2013;20(5):584-6.

Darby PJ, Kim N, Hare GM, Tsui A, Wang Z, Harrington A, et al. Anemia increases the risk of renal cortical and medullary hypoxia during cardiopulmonary bypass. Perfusion. 2013;28(6):504-11.

Gameiro J, Lopes JA. Complete blood count in acute kidney injury prediction: a narrative review. Ann Intensive Care. 2019;9:87.

Zhu J, Dong Y, Liao P, Yin X, He J, Guo L. Prognostic value of hemoglobin in patients with sepsis: A systematic review and meta-analysis. Heart Lung. 2024;64(March–April 2024):93-9.