Hi, everyone. My name is Ishan Roy. I'm a resident at Shirley Round Ability Lab in Northwestern. Today, I'll be talking about the impact of cachexia syndrome on discharge after inpatient rehab. The main purpose of this study was to look at the role of cachexia as a primary impairment for cancer patients and how it influences functional recovery during inpatient rehabilitation. And so to address this question, we performed a retrospective cohort study of 18 months worth of admissions to our oncologic services at Shirley Ryan Ability Lab. And this resulted in about 330 encounters and 250 patients. Importantly, all of these patients got their oncologic care and their prior acute care stay at Northwestern, our affiliated academic hospital. We identified patients with muscle wasting using four different markers, chronic weight loss, rapid weight loss, both of which were the threshold of greater than 5% body weight loss, chronic patients in six months, and rapid patients during acute care. Low creatinine was defined as serum creatinine lower than 0.6. Low albumin was defined as serum albumin lower than 3.5. We looked at some elements of these patients pre-rehab course, including acute care events and their cancer history. Outcome measures included the FIM scores, grip strength, six-minute walk test, and post-rehab discharge destination. If we quickly look at the demographics of these patients, the important things to note are that chronic weight loss patients and low creatinine patients skewed a little bit younger, while low albumin patients skewed a little bit older. Male patients were more likely to have chronic weight loss, whereas female patients were more likely to have low creatinine. So if we look at figure 1, these are the functional measures that we collected during inpatient rehab. And so for the first several columns up through steroids, from hematologic through steroids, these are variables that associate with muscle wasting, typically, in prior studies that we have done. And then the last four columns on the right are our four markers of muscle wasting specifically. And so what we see here is that while a number of markers associate either positively or negatively, in this case, negatively being red and positively being green, it's the serum markers in particular that cluster for both motor and cognitive FIM scores as being negative compared to the overall cancer rehab population that we have. The stars indicate that in a multivariate analysis, we can see that there is an independent association between low creatinine and motor FIM scores and low albumin and cognitive FIM scores. So then we looked at discharge destination for these patients in figure 2. And again, hematologic through steroids, those columns are the variables that sometimes associate with cachexia or muscle wasting syndrome. And then the right four columns are the markers. So here we see that infection patients and rapid weight loss patients associate with discharge to a skilled nursing facility. Acute care transfers were associated with recurrent disease, hematologic disease, increased length of stay, steroids, and low creatinine. And then patients who were homebound, meaning they were limited to home-based therapies after discharge from inpatient rehab, associated with low albumin. And this time when we run a multivariate analysis, again, with the stars indicating independent associations, we see that recurrent cancer and low creatinine independently associates with acute care transfers, while low albumin independently associates with homebound therapy. So in conclusion, what we found is that in our multivariate analysis, specifically serum markers of muscle wasting, such as low creatinine and low albumin, have an independent association with not just functional outcome measures, but also discharge destination. And so these then may be important markers to look at for functional prognosis conversations in cancer patients. Moreover, I think it demonstrates that these patients require special attention and maybe new interventions to specifically address their muscle wasting or cachexia in the future.

cachexia syndrome

muscle wasting

discharge destination

creatinine levels

albumin levels