Sullivan D H
Geriatric Research Education and Clinical Center, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205.
J Am Geriatr Soc. 1992 Aug;40(8):792-8. doi: 10.1111/j.1532-5415.1992.tb01851.x.
To test the strength of the evidence in favor of the hypothesis that protein-energy undernutrition is an independent risk factor for non-elective hospital readmission within 3 months of discharge in a population of elderly hospitalized patients.
Retrospective analysis of data from prospective observational study.
All 110 elderly patients admitted to a geriatric recuperative care and rehabilitation unit during a 6-month period completed a comprehensive in-patient evaluation. Ninety-eight of these patients were subsequently discharged alive and followed prospectively for 3 months. All hospital readmissions during the observation period were identified by patient interview and, within the VA hospital system, computer tracking of admissions. Based on the discharge assessment, the strongest predictors of non-elective readmission were identified using univariate and multivariate statistical procedures.
Twenty-eight of the 98 patients discharged alive and completing the 3-month follow-up (29%) had at least one non-elective readmission. The patients discharged home were non-electively readmitted more frequently than were the patients discharged to a nursing home (32% vs 11%, P = 0.05). Of the 109 discharge assessment variables analyzed, the best predictor of which patients would have at least one non-elective hospital readmission was the discharge serum albumin, followed by a diagnosis of dementia, discharge gamma globulin, the subscapular skinfold thickness, home ownership, and the discharge Katz Index of ADL score. Discharge serum albumin concentration, subscapular skinfold thickness, and discharge serum gamma globulin concentration were all negatively correlated with risk of non-elective readmission. The presence of functional debilitation or dementia was associated with a lower likelihood of non-elective readmission compared with the absence of these conditions.
Protein-energy undernutrition appears to be a strong independent risk factor for non-elective hospital readmission especially among the highest risk patients, those who are functionally independent and cognitively intact.
检验以下假设的证据强度：在老年住院患者群体中，蛋白质能量营养不良是出院后3个月内非选择性再次入院的独立危险因素。
对前瞻性观察性研究数据进行回顾性分析。
在6个月期间入住老年康复护理和康复单元的所有110名老年患者完成了全面的住院评估。其中98名患者随后存活出院，并进行了3个月的前瞻性随访。观察期内的所有再次入院情况通过患者访谈以及在退伍军人医院系统内通过计算机追踪入院记录来确定。根据出院评估，使用单变量和多变量统计程序确定非选择性再次入院的最强预测因素。
98名存活出院并完成3个月随访的患者中，有28名（29%）至少有一次非选择性再次入院。出院回家的患者非选择性再次入院的频率高于出院到养老院的患者（32%对11%，P = 0.05）。在分析的109个出院评估变量中，预测哪些患者至少会有一次非选择性再次入院的最佳指标是出院时血清白蛋白，其次是痴呆诊断、出院时γ球蛋白、肩胛下皮褶厚度、房屋所有权以及出院时Katz日常生活活动指数评分。出院时血清白蛋白浓度、肩胛下皮褶厚度和出院时血清γ球蛋白浓度均与非选择性再次入院风险呈负相关。与不存在这些情况相比，存在功能衰弱或痴呆与非选择性再次入院的可能性较低相关。
蛋白质能量营养不良似乎是非选择性再次入院的一个强有力的独立危险因素，尤其是在最高风险患者中，即那些功能独立且认知完好的患者。
