Patients who are ambulatory with inflammatory bowel disease (IBD) are at a greater risk of malnutrition, resulting in a longer average length of hospital stay and other negative outcomes.¹

A team, led by Benedix Sim, MBBS, Department of Gastroenterology and Hepatology, Singapore General Hospital, evaluated the prevalence of patients with IBD at risk for malnutrition in Singapore.

The prevalence of malnutrition in ambulatory patients with IBD is unknown in Singapore.

The Study

In the study, the investigators used the Malnutrition Universal Screening Tool (MUST) in the ambulatory setting to analyze clinical outcomes in this patient population.

Malnutrition was defined as a score of 2 or more on MUST and each patient was follow-up with for 6 months.

Overall, there were 217 patients recruited, 59% (n = 128) of which had ulcerative colitis and 41% (n = 89) of which had Crohn’s disease. The mean body mass index (BMI) of the patient population was 23.5 (±4.5) kg/m2. In addition, 16.1% (n = 35) of patients were treated with biologics and 24% (n = 52) of patients were treated with steroids.

The Risk of Malnutrition

The risk of malnutrition was identified in 11.5% (n = 25) of the patient population. Moreover, there was a higher proportion of patients with ulcerative colitis were at risk of malnutrition (60%; n = 15).

This group was largely underweight (92%; n = 23).

On the other hand, 59.4% (n = 114) of patients not at a risk of malnutrition were deemed overweight.

In addition, patients at a risk of malnutrition had a significantly lower mean of albumin (38.3 vs 41.9 g/L) , as well as significantly increased proportion of patients with CRP >5 mg/L (36% vs 19.3%).

There was also a trend toward longer hospital lengths of stay in the group of patients at risk of malnutrition.

However, this was not considered to be statistically significantly.

Finally, biologic or immunomodulators treatment and albumin levels were not associated with a risk for malnutrition in patients with IBD.

“Using the MUST score, 11.5% of ambulatory IBD patients in Singapore were identified to be at risk of malnutrition,” the authors wrote. “Amongst patients at risk of malnutrition, a trend was demonstrated towards a longer length of stay for admitted patients. This underscores the need to actively screen ambulatory IBD patients for malnutrition.”

IBD Mortality

Last year, investigators found a new machine learning based algorithm is able to accurately forecast inpatient mortality for patients with IBD.

A team, led by Paris Charilaou, MD, New York Presbyterian Hospital/Weill-Cornell Medical College - Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medicine, assessed inpatient mortality predictors and created a predictive model for inpatient mortality using machine-learning for hospitalized patients with IBD.

The investigators identified several risk factors associated with inpatient mortality, including increasing age, ulcerative colitis, IBD-related surgery, pneumonia, chronic lung disease, acute kidney injury, malnutrition, frailty, heart failure, blood transfusion, sepsis/septic shock, and thromboembolism.

Overall, the QLattice algorithm was the highest performing model (+LR, 3.2; 95% CI 3.0-3.3; AUC, 0.87; 85% sensitivity; 73% specificity). This model distinguished inpatient mortality by 15.6-fold when comparing high to low-risk patients.

In the surgical model cohort mode, the investigators were able to distinguish inpatient mortality by 49-fold (+LR, 8.5; AUC, 0.94; 85% sensitivity; 90% specificity).

References:

Sim, B., Cheah, M. C., Chan, W. P., Wang, Y. T., Tan, M. T., Shim, H. H., & Salazar, E. (2023). Approximately 1 in 10 ambulatory inflammatory bowel disease patients are at risk of malnutrition– a prospective Singapore cohort. Journal of Digestive Diseases. https://doi.org/10.1111/1751-2980.13165