Mortality, Adverse Outcome Odds Higher in Multiple Myeloma PEM Population

“These findings highlight the critical need to address PEM in the management of [patients with multiple myeloma] with ACHF to mitigate the associated poor clinical outcomes,” according to the study authors.

Protein-energy malnutrition (PEM) conferred a higher likelihood of all-cause mortality and other adverse outcomes among patients with multiple myeloma and acute congestive heart failure (ACHF), according to findings from a population-based analysis shared in a poster presentation at the 2025 American Association for Cancer Research Annual Meeting.¹

Across the overall population and those with PEM specifically (n = 395), the mortality rates were 5.2% and 11.4%, respectively. Compared with all other patients, those with PEM experienced longer hospital stays (9.8 days vs 5.8 days) for an adjusted incidence ratio rate (aIRR) of 1.55 (95% CI, 1.25-1.92). Additionally, those with PEM had higher hospitalization charges ($118,775 vs $59,505) vs the rest of the population for an aIRR of 1.71 (95% CI, 1.28-2.28).

Patients who had multiple myeloma with ACHF and PEM experienced higher odds of all-cause mortality (adjusted OR [aOR], 2.64; 95% CI, 1.07-6.48; P <.05), acute kidney injury (aOR,1.86; 95% CI, 1.05-3.30; P <.05), respiratory failure (aOR, 1.56; 0.93-2.62; P = .10), mechanical ventilation (aOR, 15.2; 95% CI, 1.99-116.2; P = .06), cardiogenic shock (aOR, 3.73; 95% CI, 1.27-10.92; P <.05), and vasopressor use (aOR, 4.96; 95% CI, 1.37-17.90; P<.05). Additionally, the multiple myeloma with ACHF and PEM subgroup had a lower probability of undergoing renal replacement therapy (aOR, 0.55; 95% CI, 0.17-1.76; P = .31).

“Our study revealed that [patients with] multiple myeloma with PEM admitted with ACHF had significantly higher odds of all-cause mortality and other adverse outcomes compared to those without PEM. They also experienced longer hospital stays and incurred higher hospitalization charges,” lead study author Adamsegd I. Gebremedhen, MD, from the Department of Internal Medicine at Marshall University School of Medicine, wrote with coauthors.¹ “These findings highlight the critical need to address PEM in the management of [patients with multiple myeloma] with ACHF to mitigate the associated poor clinical outcomes.”

According to the study authors, multiple myeloma often confers the risk of heart failure due to a high-output state, light-chain cardiac amyloidosis, or therapies like proteasome inhibitors.² Additionally, anemia and other complications associated with multiple myeloma can exacerbate heart failure that confers acute decompensation and higher hospitalization rates.

The investigators noted that PEM is common in patients with multiple myeloma and can be associated with poorer outcomes and longer hospital stays. Additionally, they described how the impact of PEM on outcomes among those with multiple myeloma and ACHF has not been extensively studied. With this background in mind, investigators aimed to assess how PEM influenced in-hospital outcomes for those with multiple myeloma and ACHF.

The study identified adults with multiple myeloma from the National Inpatient Sample who had a primary diagnosis of ACHF between 2018 and 2021 via ICD-10 codes. Investigators categorized the patient cohort based on the presence or lack of PEM while applying complex sampling weights to ensure national representation.

The primary end point of the study was all-cause mortality. Evaluation of outcome disparities between groups involved the use of multivariate regression models; statistical significance was set at P <.05.

In the non-PEM (n = 1995) and PEM (n = 395) populations, the mean age was 71.1 years compared with 70.5 years (P = .66). In each respective group, 40.5% and 59.5% were male (P <.05), 70.9% and 66.7% were White (P = .29), and 12.5% and 3.8% had obesity (P <.05). Valvular heart disease was noted in 29.3% and 17.7% of patients in each cohort (P <.05).

References

1. Gebremedhen AI, Mohammed A, Souleymane M, et al. Epidemiology, clinical outcomes, and healthcare resource utilization in multiple myeloma patients with protein-energy malnutrition hospitalized for acute congestive heart failure: a comprehensive population-based analysis. Presented at the 2025 American Association for Cancer Research Annual Meeting; April 25-30, 2025; Chicago, IL. Poster CL12.01.
2. Carlisi M, Mancuso S, Lo Presti R, Siragusa S, Caimi G. High output heart failure in multiple myeloma: pathogenetic considerations. Cancers (Basel). 2022;14(3):610. doi:10.3390/cancers14030610.