Kyle Ursula G, Pirlich Matthias, Schuetz Tatjana, Lochs Herbert, Pichard Claude
Department of Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland.
JPEN J Parenter Enteral Nutr. 2004 Mar-Apr;28(2):99-104. doi: 10.1177/014860710402800299.
Malnutrition is common at hospital admission and tends to worsen during hospitalization. This controlled population study aimed to determine if serum albumin or moderate and severe nutritional depletion by Nutritional Risk Index (NRI) at hospital admission are associated with increased length of hospital stay (LOS) (and increased hospital cost) in patients admitted to hospitals in 2 European countries.
Serum albumin levels and recent weight loss were prospectively determined at hospital admission in Geneva (n = 652) and Berlin (n = 621). Patients were classified as no, mild, moderate or severe risk by NRI. Multiple logistic regressions were used to determine the association between albumin and nutritional risk category and LOS.
Patients (24%) were at moderate or severe nutritional risk by NRI. Nutritional risk by NRI, adjusted for age, was associated with LOS of 11 days (moderate: odds ratio [OR] 1.9, 95% confidence interval [CI] 1.4 to 2.7, p < .005; severe: OR 2.9, 95% CI 1.6 to 5.3, p < .005). Serum albumin was also significantly associated with increased LOS (p < .001).
The prevalence of nutritional depletion assessed by NRI and albumin was increased with longer LOS. Albumin alone underestimated nutritional risk. Severe nutritional depletion by NRI was significantly associated with LOS > or = 11 days in Geneva and Berlin patients. Nutrition screening should take place at hospital admission to determine nutritional risk and risk for longer LOS.
营养不良在住院时很常见，且在住院期间往往会加重。这项对照人群研究旨在确定在两个欧洲国家住院的患者入院时血清白蛋白水平或通过营养风险指数（NRI）评估的中度和重度营养消耗是否与住院时间延长（以及住院费用增加）相关。
前瞻性地测定了日内瓦（n = 652）和柏林（n = 621）患者入院时的血清白蛋白水平和近期体重减轻情况。根据NRI将患者分为无风险、轻度风险、中度风险或重度风险。采用多元逻辑回归分析来确定白蛋白和营养风险类别与住院时间之间的关联。
根据NRI，24%的患者存在中度或重度营养风险。校正年龄后，NRI评估的营养风险与11天的住院时间相关（中度：比值比[OR] 1.9，95%置信区间[CI] 1.4至2.7，p <.005；重度：OR 2.9，95% CI 1.6至5.3，p <.005）。血清白蛋白水平也与住院时间延长显著相关（p <.001）。
通过NRI和白蛋白评估的营养消耗患病率随住院时间延长而增加。仅白蛋白水平会低估营养风险。在日内瓦和柏林的患者中，NRI评估的重度营养消耗与住院时间≥11天显著相关。应在入院时进行营养筛查，以确定营养风险和住院时间延长的风险。
