Thiamine Deficiency Is Common Among Emergency Department Oncology Patients
Grahf D, Dabbagh F, France J, Rose K, Chaudhry K, Muminovic M, Harris A, and Miller J. Thiamine deficiency is common among emergency department oncology patients. Acad Emerg Med 2018; 25:S122.
Acad Emerg Med
Background: Thiamine deficiency is associated with significant morbidity that may be precipitated by acute illness. Due to metabolic demands of cancer and difficulty maintaining adequate nutrition, oncology patients may be at higher risk of thiamine deficiency when acutely ill. Our primary objective was to quantify the prevalence of thiamine deficiency among ED oncology patients. Methods: This was a prospective, single center observational study. Inclusion criteria were adult patients with active malignancy presenting to the ED. We excluded patients with known cirrhosis or liver cancer due to known alterations in thiamine metabolism. Data collection included demographic and clinical information, including cancer type and albumin as a marker of nutritional status. We sent whole blood for thiamine levels (Warde Laboratories, Ann Arbor, MI). Analysis was descriptive but also included univariate analysis to test risk factors for thiamine deficiency. Results: There were 55 patients. The mean age was 63 ± 14 years, 53% were female, and 64% African American. The most common malignancies were lung (26%), colon (11%) and breast (11%) cancer. Metastatic disease was present in 43% of patients, and 52% of patients were undergoing current chemotherapy. Mean body mass index (BMI) and albumin were 26.7 ± 6.1 kg/m2 and 3.4 ± 0.8 g/dL, respectively. The rate of thiamine deficiency was 31% (95% CI 19 - 45%). There was no statistical difference in age (p=0.99), BMI (p=0.17), albumin (p=0.91), or gender (p=0.36) between patients with or without thiamine deficiency. 39% of patients with metastatic disease had thiamine deficiency compared to 23% without metastatic disease but the difference did not reach statistical significance (p=0.19). Conclusion: In this cohort of ED oncology patients, there was a surprisingly high rate of thiamine deficiency. Further work is indicated to delineate risk factors and attributable morbidity.