The relationship of functional status, nutritional assessment, and severity of illness to in-hospital mortality.

BACKGROUND

Prediction of in-hospital mortality may direct hospital resources towards those patients most at risk. A number of single domain risk instruments have been developed, indicating that functional status, nutritional assessment, and severity of illness individually predict in-hospital mortality. The interaction among these predictors is less well described.

OBJECTIVE

To determine the relationship of functional status, nutritional assessment, and severity of illness to in-hospital mortality.

DESIGN, SETTING, SUBJECTS: Cohort study of 1712 consecutive admissions over a one year period to an Internal Medical Service at a tertiary university teaching hospital.

MAIN OUTCOME MEASURES

Death during hospital admission.

RESULTS

Dependency in activities of daily living (OR = 3.37, 95% CI 1.78 to 6.37, p = 0.0002) and body mass index less than 20 (OR = 2.38, 95% CI 1.20 to 4.74, p = 0.01) predicted in-hospital mortality after adjusting for nutritional risk assessment, and severity of illness score.

CONCLUSIONS

Impairment in functional status and low body mass index produce the best predictors of inhospital mortality, after adjusting for nutritional risk and severity of illness score. Among these factors, functional impairment may be amenable to correction.