e23225 Background: Cancer cachexia is a multisystem metabolic syndrome characterized by involuntary tissue catabolism and systemic inflammation. In pivotal randomized interventional trials, cachexia has been defined as a composite syndrome incorporating nutritional, inflammatory, and tissue-loss domains. This trial-anchored framework was applied to a national inpatient cohort to evaluate associations with acute outcomes among hospitalized lung cancer patients. Methods: A survey-weighted analysis of the National Inpatient Sample (2016–2022) was conducted among adult lung cancer hospitalizations identified using ICD-10-CM code C34*, excluding childbirth- and delivery-related admissions. Cachexia was defined using a trial-anchored, multi-domain syndromic framework requiring ≥1 ICD-10–mapped domain: nutritional depletion (E43, E44, E46, R62. 7, R63. 4), skeletal muscle loss (M62. 84, M62. 5*), systemic inflammatory or metabolic burden (E88. 09, R77. 0), or clinician-recognized cachexia (R64) ; burden was categorized as 0, 1, or ≥2 domains. The primary outcome was in-hospital mortality; secondary outcomes included sepsis (A40/A41, R65. 20, R65. 21), acute kidney injury (N17*), ICU-level care proxied by invasive mechanical ventilation (5A1935Z, 5A1945Z, 5A1955Z), length of stay, and CCR-adjusted cost. Results: The weighted cohort comprised 3, 197, 184 hospitalizations (unweighted n = 639, 437). Cachexia prevalence was 25. 3%, with domain prevalences of nutritional depletion 22. 2%, skeletal muscle loss 0. 16%, inflammatory/metabolic burden 1. 69%, and clinician-recognized cachexia 5. 45%. Unadjusted outcomes were worse among hospitalizations with cachexia versus without: mortality 13. 35% vs 7. 40%, sepsis 20. 17% vs 12. 14%, acute kidney injury 21. 73% vs 16. 03%, and invasive mechanical ventilation 7. 15% vs 4. 80%. Mean length of stay was 7. 96 vs 5. 50 days, mean cost 24, 662 vs 20, 336, and mean charges 91, 313 vs 74, 016. After adjustment, cachexia was independently associated with higher in-hospital mortality (aOR 1. 79, 95% CI 1. 75–1. 83), with a graded dose–response by domain burden (1 domain aOR 1. 68, 95% CI 1. 64–1. 72; ≥2 domains aOR 2. 45, 95% CI 2. 34–2. 55). Cachexia was also associated with sepsis (aOR 1. 57, 95% CI 1. 54–1. 60), acute kidney injury (aOR 1. 26, 95% CI 1. 24–1. 28), invasive mechanical ventilation (aOR 1. 40, 95% CI 1. 36–1. 44), longer length of stay (+2. 26 days), and higher hospitalization cost (+5, 132). Conclusions: A trial-anchored, syndromic cachexia phenotype is common among hospitalized lung cancer patients and identifies a graded, dose-dependent inpatient vulnerability signature associated with increased mortality, complications, and resource utilization. This framework translates cachexia trial concepts into real-world inpatient oncology and offers a scalable phenotype for risk stratification and evaluation of emerging anti-cachexia therapies.
Jones et al. (Thu,) studied this question.