老年患者出院后1年内的营养不良与死亡风险

Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge.

作者信息

Liu Longjian, Bopp Melinda M, Roberson Paula K, Sullivan Dennis H

机构信息

Geriatrics Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock 72205, USA.

出版信息

J Gerontol A Biol Sci Med Sci. 2002 Nov;57(11):M741-6. doi: 10.1093/gerona/57.11.m741.

DOI:10.1093/gerona/57.11.m741

PMID:12403803

Abstract

BACKGROUND

The importance of undernutrition as a determinant of postdischarge mortality among hospitalized elderly people remains controversial. The purpose of this study was to investigate this issue.

METHODS

The study included 660 elderly patients (85% white, 98% men, average age 73 +/- 6 years) discharged from a university-affiliated Department of Veterans Affairs Hospital, who were followed for 1 year. Associations between patient characteristics at hospital discharge and mortality were identified utilizing Cox Proportional Hazards Regression analysis.

RESULTS

In the year following hospital discharge, 85 subjects (13%) died. After adjusting for illness severity (Acute Physiology and Chronic Health Evaluation II score) and functional status (Katz Index of Activities of Daily Living score), a body mass index (BMI) </=20 kg/m(2) was strongly associated with mortality (adjusted relative risk, [95% confidence interval] 1.83 [1.17-2.85]), as was more than 10% weight loss in the prior year (2.31 [1.35-3.94]), and weight as percent of usual weight (WPU) </=85% (1.78 [1.14-2.77]). Albumin </=30 g/l was only weakly associated with mortality (1.10 [0.67-1.81]). When all of the putative nutrition variables were included in a multivariable analysis with the two control variables, only BMI followed by WPU </=85% entered the model. Utilizing this model, the predicted probabilities of death at 1 year were calculated for the study subjects and for a hypothetical group of patients who were identical to the study subjects except they were assigned a BMI of 28 kg/m(2) and their WPU was 100%. Compared to 24% of the actual subjects, only 7% of the hypothetical well-nourished patients would have been classified as being at high risk for mortality (a 71% relative reduction).

CONCLUSIONS

Older patients who have evidence of chronic body mass depletion are at significantly increased risk of mortality within the year following hospital discharge.

摘要

背景

营养不良作为住院老年人出院后死亡率的一个决定因素，其重要性仍存在争议。本研究旨在调查这一问题。

方法

该研究纳入了660名从一所大学附属退伍军人事务部医院出院的老年患者（85%为白人，98%为男性，平均年龄73±6岁），并对他们进行了为期1年的随访。利用Cox比例风险回归分析确定出院时患者特征与死亡率之间的关联。

结果

出院后的一年中，85名受试者（13%）死亡。在调整疾病严重程度（急性生理与慢性健康状况评价II评分）和功能状态（日常生活活动能力Katz指数评分）后，体重指数（BMI）≤20kg/m²与死亡率密切相关（调整后的相对风险，[95%置信区间]为1.83[1.17 - 2.85]），前一年体重减轻超过10%（2.31[1.35 - 3.94]）以及体重占平常体重的百分比（WPU）≤85%（1.78[1.14 - 2.77]）也与死亡率密切相关。白蛋白≤30g/l与死亡率的关联较弱（1.10[0.67 - 1.81]）。当所有假定的营养变量与两个控制变量一起纳入多变量分析时，只有BMI以及随后的WPU≤85%进入了模型。利用该模型，计算了研究对象以及一组假设患者在1年时的预测死亡概率，这些假设患者除了BMI被设定为28kg/m²且WPU为100%外，其他方面与研究对象相同。与实际受试者中的24%相比，只有7%的假设营养良好的患者会被归类为高死亡风险（相对降低71%）。