(438) Association Between Malnutrition and Clinical Outcomes in Critically Ill Children

Introduction: Patients who are malnourished have worse outcomes. Compared to adults, children are more likely to be undernourished due to lower body fat and muscle mass and higher energy requirements per kilogram of body weight. The Virtual Pediatric Systems, LLC (VPS), a data registry for pediatric intensive care units (PICU), has an optional nutrition module that captures data for nutritional metrics. We designed this study to compare mortality rates and length of stay (LOS) in critically ill children who are malnourished to mortality rates and LOS in those who are not malnourished. We hypothesized that malnourished critically ill children would have worse outcomes than critically ill children who were not malnourished. Specifically, children who screened malnourished at PICU admission would be more likely to die during their PICU course and have a longer LOS in the PICU and hospital.

Methods: We obtained VPS data from Oct 2019-Dec 2023 from the 18 sites participating in the nutrition module. We categorized subjects as malnourished or not malnourished based on the nutrition screen at admission to PICU. We compared mortality rates between the two groups by Chi-square test. We compared PICU and Hospital LOS by Mann-Whitney-Wilcoxon test. We then performed logistic regression or general linear model to control for severity of illness using PRISM3, demographic and clinical factors.

Results: We had data for 33,529 patients, of which 6,885 (20.5%) screened as malnourished. Patients who screened as malnourished were more likely to die during their PICU stay than patients who screened as not malnourished, (2.4% vs. 1.2%), p< 0.0001. This remained significant after adjusting for age, race/ethnicity, PRISM3, and clinical factors, OR and 95% CI 2.2 (1.7-2.8), p< 0.0001. Patients who screened as malnourished had longer PICU LOS [geometric mean and 95% CI 2.9 (2.8-3.0) vs. 1.8 (1.7-1.9) days], and hospital LOS [6.8 (7.1-7.5) vs. 3.8 (3.7-4.0) days], (both p< 0.0001, adjusted for age, race/ethnicity, PRISM3 and clinical factors) than patients who screened as not malnourished.

Conclusions: We found higher mortality rates and longer PICU and hospital LOS in critically ill children who were screened as malnourished than in those who were not, even after adjusting for age, race/ethnicity, PRISM3 and other clinical factors.