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Association between metabolic obesity phenotypes and multiple myeloma hospitalization burden: A national
Yue Zhang1,2,3,4,5, Xiude Fan2,3,4,5, Chunhui Zhao1,2,3,4,5
1Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China.
Background & Purpose:
Obesity and metabolic disorders were associated with increased risk of MM, a disease characterized by high risk of relapsing and require frequent hospitalizations. In this study, we conducted a retrospective cohort study to explore the association of metabolic obesity phenotypes with the readmission risk of MM.
Patients & Methods:
We analyzed 34,852 patients diagnosed with MM from the Nationwide Readmissions Database (NRD), a nationally representative database from US. Hospitalization diagnosis of patients were obtained using ICD-10 diagnosis codes. According to obesity and metabolic status, the population was divided into four phenotypes: metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). The patients with different phenotypes were observed for hospital readmission at days 30-day, 60-day, 90-day and 180-day. Multivariate cox regression model was used to estimate the relationship between obesity metabolic phenotypes and readmissions risk.
Results:
There were 5,400 (15.5%), 7,255 (22.4%), 8,025 (27.0%) and 7,839 (35.6%) unplanned readmissions within 30-day, 60-day, 90-day and 180-day follow-up, respectively. For 90-day and 180-day follow-up, compared with patients with the MHNO phenotype, those with metabolic unhealthy phenotypes MUNO (90-day: P = 0.004; 180-day: P = < 0.001) and MUO (90-day: P = 0.049; 180-day: P = 0.004) showed higher risk of readmission, while patients with only obesity phenotypes MHO (90-day: P = 0.170; 180-day: P = 0.090) experienced no higher risk. However, similar associations were not observed for 30-day and 60-day. Further analysis in 90-day follow-up revealed that, readmission risk elevated with the increase of the combined factor numbers, with aHR of 1.068 (CI: 1.002-1.137, P = 0.043, with one metabolic risk factor), 1.109 (CI: 1.038-1.184, P = 0.002, with two metabolic risk factors) and 1.125 (95% CI: 1.04-1.216, P = 0.003, with three metabolic risk factors), respectively.
Conclusion:
Metabolic disorders, rather than obesity, were independently associated with higher readmission risk in patients with MM, whereas the risk elevated with the increase of the number of combined metabolic factors. However, the effect of metabolic disorders on MM readmission seems to be time-dependent. For MM patient combined with metabolic disorders, more attention should be paid to advance directives to reduce readmission rate and hospitalization burden.
Insights
Metabolic disorders, not obesity, increase multiple myeloma readmission risk. Higher risk is linked to more metabolic factors, especially beyond 90 days. Advance directives can help manage this.
Area of Science:
- Metabolic health and obesity research
- Clinical outcomes in multiple myeloma
Background:
- Multiple myeloma (MM) patients face high relapse and hospitalization rates.
- Obesity and metabolic disorders are linked to increased MM risk.
Purpose of the Study:
- To investigate the association between metabolic obesity phenotypes and MM readmission risk.
- To identify specific metabolic factors influencing MM patient outcomes.
Main Methods:
- Retrospective cohort study of 34,852 MM patients from the Nationwide Readmissions Database (NRD).
- Classification into four phenotypes: metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO).
- Multivariate Cox regression analysis to assess readmission risk at 30, 60, 90, and 180 days.
Main Results:
- Metabolically unhealthy phenotypes (MUNO, MUO) showed significantly higher readmission risk at 90 and 180 days compared to MHNO.
- Metabolically healthy obese (MHO) phenotype did not show increased readmission risk.
- Readmission risk increased with the number of metabolic risk factors, particularly beyond 90 days.
Conclusions:
- Metabolic disorders, not obesity itself, are independently associated with higher MM readmission risk.
- The impact of metabolic disorders on MM readmission is time-dependent, increasing significantly after 90 days.
- Focusing on metabolic health and advance directives may reduce MM readmission rates and hospitalization burden.
