Protein-Energy Malnutrition Among Children with Sepsis: Trends, Risk Factors, Outcomes and Rising incidence from the National Inpatient Sample (2010-2019)

Background Protein-energy malnutrition (PEM) following sepsis in pediatric patients represents a significant clinical challenge, yet its risk factors remain incompletely characterized. Methods This cross-sectional study analyzed data from the National Inpatient Sample database (2010–2019) to identify risk factors associated with PEM in pediatric sepsis patients (PEM-PSP). Cases were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM codes, and cases with incomplete data were excluded from the analysis. The relationship between clinical variables and the occurrence of PEM was evaluated using logistic regression, with statistical analysis employed to assess the significance of these associations. Results Of the 45,876 patients with pediatric sepsis, 2,244 (0.05%) developed PEM. The incidence of PEM increased from 2.7% in 2010 to 6.6% in 2019. Increased risk was observed in pediatric patients with multiple comorbidities (≥3: OR = 3.036, 95% CI: 2.126–4.264), treated at an urban hospital (OR = 9.028, 95% CI: 3.290-24.778), and aged 2–17 years. PEM was associated with longer hospital stays (21.0 vs. 7.0 days, p  < 0.001), higher healthcare costs ($244,428.50 versus $60,261.00, p  < 0.001), and increased mortality (9.0% vs 7.7%, p  < 0.001). Documented heart failure (OR = 2.341, 95% CI: 1.933–2.835) was significantly associated with the development of PEM. Conclusions Several risk factors are associated with the development of PEM-PSP, with infants and patients with multiple comorbidities being particularly at risk. Early identification of high-risk patients can facilitate the implementation of targeted nutritional interventions to improve outcomes. Besides, mechanisms linking pediatric sepsis and protein-energy malnutrition may contribute to the observed increase in the incidence of protein-energy malnutrition following pediatric sepsis over the study period.