Khalatbari-Soltani Saman, Marques-Vidal Pedro
Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopole 2, Route de la Corniche 10, CH-1010 Lausanne, Switzerland; Department of Internal Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Department of Internal Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Clin Nutr. 2016 Dec;35(6):1340-1346. doi: 10.1016/j.clnu.2016.02.012. Epub 2016 Mar 3.
BACKGROUND & AIMS: Hospitalized patients should be screened for nutritional risk and adequately managed. Being nutritionally 'at-risk' increases in-hospital mortality, length of stay (LOS) and costs, but the impact on actual costs has seldom been assessed. We aimed to determine nutritional risk screening and management in a Swiss university hospital. The impact of being nutritionally 'at-risk' on in-hospital mortality, LOS and costs was also assessed.
Retrospective analysis of administrative data for years 2013 and 2014 from the department of internal medicine of the Lausanne university hospital (8541 hospitalizations, mean age 72.8 ± 16.5 years, 50.4% women). Being nutritionally 'at-risk' was defined as a Nutritional risk screening-2002 score ≥ 3 and nutritional managements were collected from medical records.
Screening increased from 16.5% in 2013 to 41.9% in 2014 (p < 0.001), while prevalence of 'at-risk' patients remained stable (64.6% in 2013 and 62.7% in 2014, p = 0.37). Prevalence of 'at-risk' patients was highest in patients with cancer (85.3% in 2013 and 70.2% in 2014) and lowest in patients with disease of skin (42% in 2013 and 44.8% in 2014). Less than half of patients 'at-risk' received any nutritional management, and this value decreased between 2013 and 2014 (46.9% vs. 40.3%, p < 0.05). After multivariate adjustment, 'at-risk' patients had a 3.7-fold (95% confidence interval: 1.91; 7.03) higher in-hospital mortality and higher costs (excess 5642.25 ± 1479.80 CHF in 2013 and 5529.52 ± 847.02 CHF in 2014, p < 0.001) than 'not at-risk' patients, while no difference was found for LOS.
Despite an improvement in screening, management of nutritionally 'at-risk' patients is not totally covered yet. Being nutritionally 'at-risk' affects three in every five patients and is associated with increased mortality and hospitalization costs.
应对住院患者进行营养风险筛查并给予适当管理。存在营养“风险”会增加住院死亡率、住院时间（LOS）及费用，但对实际费用的影响鲜有评估。我们旨在确定瑞士一家大学医院的营养风险筛查与管理情况。同时评估了存在营养“风险”对住院死亡率、住院时间及费用的影响。
对洛桑大学医院内科2013年和2014年的管理数据进行回顾性分析（共8541例住院病例，平均年龄72.8±16.5岁，女性占50.4%）。将营养“风险”定义为营养风险筛查-2002评分≥3，并从病历中收集营养管理情况。
筛查率从2013年的16.5%升至2014年的41.9%（p<0.001），而“风险”患者的患病率保持稳定（2013年为64.6%，2014年为62.7%，p = 0.37）。“风险”患者患病率在癌症患者中最高（2013年为85.3%，2014年为70.2%），在皮肤病患者中最低（2013年为42%，2014年为44.8%）。不到一半的“风险”患者接受了任何营养管理，且该数值在2013年至2014年期间有所下降（46.9%对40.3%，p<0.05）。多因素调整后，“风险”患者的住院死亡率比“无风险”患者高3.7倍（95%置信区间：1.91；7.03），费用也更高（2013年额外费用为5642.25±1479.80瑞士法郎，2014年为5529.52±847.02瑞士法郎，p<0.001），而住院时间未发现差异。
尽管筛查有所改善，但营养“风险”患者的管理仍未完全覆盖。每五名患者中就有三名存在营养“风险”，且与死亡率和住院费用增加相关。
