School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, Australia.
Eur J Clin Nutr. 2012 Nov;66(11):1224-8. doi: 10.1038/ejcn.2012.130. Epub 2012 Sep 19.
BACKGROUND/OBJECTIVES: Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up.
SUBJECTS/METHODS: A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n = 476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates.
At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P<0.001). Hazard rate for death in the malnourished group is 3.41 (95% confidence interval: 1.07-10.87; P = 0.038) times the well-nourished group. Discharge to a higher level of residential care was 33.1%, 16.9% and 4.9% for malnourished, at-risk and well-nourished patients, respectively; P ≤ 0.001).
Malnutrition in elderly subacute patients predicts adverse clinical outcomes and identifies a need to target this population for nutritional intervention following hospital discharge.
背景/目的：与营养良好的患者相比，老年营养不良患者的手术并发症更多，发病率更高。本研究旨在评估入院时的营养状况是否预测 18 个月随访时的临床结局。
受试者/方法：对澳大利亚新南威尔士州两家亚急性医院 2076 例（年龄≥65 岁）患者入院的回顾性分析。在 n=476 例亚样本中，根据入院时的营养状况分析 18 个月时的结局。入院后 72 小时内使用微型营养评估量表（MNA）确定营养状况。从电子病历中获取结局数据，包括住院再入院率、总住院时间（LOS）、出院时护理水平的变化和死亡率。使用 Cox 比例风险模型进行生存分析，包括年龄、性别、主要疾病分类、入院时的活动能力和 LOS 作为协变量。
在基线时，30%的患者存在营养不良，53%的患者有营养不良风险。与营养良好的患者相比，营养不良和有风险的患者的 LOS 更高（中位数（四分位距）：34（21，58）；26（15，41）；20（14，26）天，分别；P<0.001）。营养不良组的死亡风险率是营养良好组的 3.41 倍（95%置信区间：1.07-10.87；P=0.038）。营养不良、有风险和营养良好的患者出院后转至更高水平的居住护理的比例分别为 33.1%、16.9%和 4.9%；P≤0.001）。
老年亚急性患者的营养不良预测不良临床结局，并表明需要针对这一人群在出院后进行营养干预。
