Pretransplant muscle status as a predictive marker for diarrhea duration and hospital length of stay in patients undergoing hematopoietic stem cell transplantation: a prospective cohort analysis.

OBJECTIVES

To examine the impact of pretransplant muscle status on diarrhea duration and length of stay (LOS) following hematopoietic stem cell transplantation (HSCT).

METHODS

This was a secondary analysis from a prospective study. All of the participants were adult HSCT inpatients between 2022 and 2024. Muscle status was evaluated using height-adjusted appendicular skeletal muscle mass (ASM) and handgrip. The patients were classified into two groups: "Group A": height-adjusted ASM above standard (≥ male 7.0 kg/m2, female 5.7 kg/m2) AND handgrip above standard (≥ male 28kg, female 18kg); "Group B": either height-adjusted ASM OR handgrip below above-mentioned standard. Diarrhea was defined as the passage of more than three loose stools daily, as per the Bristol Stool Chart, within 14 d of transplantation. LOS was defined as the number of days from the date of admission to discharge.

RESULTS

Overall, 96 patients (52.1% male) aged 52.7 ± 12.8 y were enrolled, of whom one-fourth had abnormal muscle status. After full adjustment for relevant confounders, a longer diarrhea duration was associated with abnormal muscle status (incidence rate ratio, 1.7, 95% confidence interval, 1.2-2.3, P = 0.002). Similarly, a longer LOS was associated with abnormal muscle status (incidence rate ratio, 1.3, 95% confidence interval, 1.1-1.5, P = 0.007). The association with diarrhea duration was consistent across conditioning therapy but more pronounced in patients with multiple myeloma or lower pretransplant protein intake.

CONCLUSIONS

Pretransplant muscle status was associated with the diarrhea duration within 14 d of transplantation and LOS in HSCT patients. These results support pretransplant nutritional assessment and early intervention to maintain muscle status.