Nutrition and Dietetics Service, Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Policlinico San Matteo, Pavia, Italy.
CMAJ. 2010 Nov 23;182(17):1843-9. doi: 10.1503/cmaj.091977. Epub 2010 Oct 12.
Comprehensive evaluations of the nutritional parameters associated with length of hospital stay are lacking. We investigated the association between malnutrition and length of hospital stay in a cohort of ambulatory adult patients.
From September 2006 to June 2009, we systematically evaluated 1274 ambulatory adult patients admitted to hospital for medical or surgical treatment. We evaluated the associations between malnutrition and prolonged hospital stay (> 17 days [> 75th percentile of distribution]) using multivariable log-linear models adjusted for several potential nutritional and clinical confounders recorded at admission and collected during and at the end of the hospital stay.
Nutritional factors associated with a prolonged hospital stay were a Nutritional Risk Index score of less than 97.5 (relative risk [RR] 1.64, 95% confidence interval [CI] 1.31-2.06) and an in-hospital weight loss of 5% or greater (RR 1.60, 95% CI 1.30-1.97). Sensitivity analysis of data for patients discharged alive and who had a length of stay of at least three days (n = 1073) produced similar findings (adjusted RR 1.51, 95% CI 1.20-1.89, for Nutritional Risk Index score < 97.5). A significant association was also found with in-hospital starvation of three or more days (RR 1.14, 95% CI 1.01-1.28).
Nutritional risk at admission was strongly associated with a prolonged hospital stay among ambulatory adult patients. Another factor associated with length of stay was worsening nutritional status during the hospital stay, whose cause-effect relationship with length of stay should be clarified in intervention trials. Clinicians need to be aware of the impact of malnutrition and of the potential role of worsening nutritional status in prolonging hospital stay.
目前缺乏全面评估与住院时间相关的营养参数的研究。我们研究了营养不足与门诊成年患者住院时间之间的关系。
2006 年 9 月至 2009 年 6 月，我们系统评估了 1274 名因医疗或外科治疗而住院的门诊成年患者。我们使用多变量线性模型评估了营养不足与住院时间延长（> 17 天[> 分布的第 75 个百分位数]）之间的关联，这些模型调整了入院时以及住院期间和结束时记录的几个潜在营养和临床混杂因素。
与住院时间延长相关的营养因素包括营养风险指数评分<97.5（相对风险[RR] 1.64，95%置信区间[CI] 1.31-2.06）和住院期间体重减轻 5%或更多（RR 1.60，95% CI 1.30-1.97）。对存活并至少住院三天的患者（n = 1073）的数据进行敏感性分析，结果相似（营养风险指数评分<97.5 的调整 RR 1.51，95% CI 1.20-1.89）。住院期间禁食 3 天或以上也与住院时间延长显著相关（RR 1.14，95% CI 1.01-1.28）。
入院时的营养风险与门诊成年患者的住院时间延长密切相关。住院期间营养状况恶化也是与住院时间延长相关的另一个因素，其与住院时间延长的因果关系需要在干预试验中阐明。临床医生需要认识到营养不良的影响以及营养状况恶化在延长住院时间方面的潜在作用。
