School of Nutrition, Puc-Campinas-SP, Brazil.
JPEN J Parenter Enteral Nutr. 2011 Mar;35(2):241-8. doi: 10.1177/0148607110374477. Epub 2010 Oct 22.
To diagnose the nutrition status of hospitalized patients and identify the risk factors associated with hospital length of stay (LOS).
The subjective approach and the body mass index (BMI) were used to classify the nutrition status, and other indicators (anthropometry, biochemistry, and energy intake) were analyzed regarding their association with length of hospital stay of 350 patients. The chi-square test was used to compare proportions, and the Mann-Whitney or Kruskal-Wallis test was used to compare continuous measures. Linear association was verified using Spearman's rank correlation coefficient. Cox's regression model was used to investigate factors associated with LOS.
Disease was the factor that influenced LOS the most in the studied population. Longer LOS prevailed in males (P < .0001), patients aged ≥60 years (P = .0008), patients with neoplasms (P < .0001), patients who lost weight during their hospital stay (P < .0001), and malnourished patients (P = .0034). There was a negative and significant, but weak, correlation between LOS and nutrition indicators (calf circumference, arm circumference, triceps skinfold thickness, subscapular skinfold thickness, arm fat area, lymphocyte count, and hemoglobin). Among adults, well-nourished patients were 3 times more likely to be discharged sooner (P = .0002, RR = 3.3 [1.7-6.2]) than those who had some degree of malnutrition. Well-nourished patients with digestive tract diseases (DTD) were also discharged sooner than malnourished patients with the same condition (P = .02, RR = 2.5 [1.1-5.8]). In patients with neoplasms, arm circumference was an independent risk factor to assess LOS (P = .009, RR = 1.1 [1.0-1.1]).
LOS was associated with disease and nutrition status. Among the more common diseases, nutrition status according to the subjective approach determined the LOS for patients with DTD and nutrition status according to arm circumference determined the LOS for patients with neoplasms.
诊断住院患者的营养状况，并确定与住院时间（LOS）相关的风险因素。
采用主观评估和体重指数（BMI）对营养状况进行分类，并对 350 名患者的其他指标（人体测量学、生物化学和能量摄入）进行分析，以探讨其与 LOS 的关系。采用卡方检验比较比例，采用曼-惠特尼或克鲁斯卡尔-沃利斯检验比较连续变量。采用斯皮尔曼等级相关系数验证线性关联。采用 Cox 回归模型探讨与 LOS 相关的因素。
在所研究的人群中，疾病是影响 LOS 最主要的因素。男性（P <.0001）、年龄≥60 岁（P =.0008）、患有肿瘤（P <.0001）、住院期间体重减轻（P <.0001）和营养不良的患者（P =.0034）的 LOS 更长。LOS 与营养指标（小腿围、臂围、三头肌皮褶厚度、肩胛下皮褶厚度、臂脂肪区、淋巴细胞计数和血红蛋白）呈负相关，但相关性较弱。在成年人中，营养良好的患者出院更早的可能性是存在某种程度营养不良患者的 3 倍（P =.0002，RR = 3.3 [1.7-6.2]）。患有消化系统疾病（DTD）且营养良好的患者也比患有相同疾病且营养不良的患者出院更早（P =.02，RR = 2.5 [1.1-5.8]）。在患有肿瘤的患者中，臂围是评估 LOS 的独立危险因素（P =.009，RR = 1.1 [1.0-1.1]）。
LOS 与疾病和营养状况有关。在更常见的疾病中，根据主观评估确定 DTD 患者 LOS 的是营养状况，而根据臂围确定肿瘤患者 LOS 的是营养状况。
