老年人营养不良及其与出院后 7 天内和 8-180 天内再入院和死亡的相关性：一项前瞻性观察研究。
Malnutrition and its association with readmission and death within 7 days and 8-180 days postdischarge in older patients: a prospective observational study.
机构信息
Department of General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia.
School of Medicine, Flinders University, Adelaide, South Australia, Australia.
出版信息
BMJ Open. 2017 Nov 12;7(11):e018443. doi: 10.1136/bmjopen-2017-018443.
OBJECTIVE
The relationship between admission nutritional status and clinical outcomes following hospital discharge is not well established. This study investigated whether older patients' nutritional status at admission predicts unplanned readmission or death in the very early or late periods following hospital discharge.
DESIGN, SETTING AND PARTICIPANTS: The study prospectively recruited 297 patients ≥60 years old who were presenting to the General Medicine Department of a tertiary care hospital in Australia. Nutritional status was assessed at admission by using the Patient-Generated Subjective Global Assessment (PG-SGA) tool, and patients were classified as either nourished (PG-SGA class A) or malnourished (PG-SGA classes B and C). A multivariate logistic regression model was used to adjust for other covariates known to influence clinical outcomes and to determine whether malnutrition is a predictor for early (0-7 days) or late (8-180 days) readmission or death following discharge.
OUTCOME MEASURES
The impact of nutritional status was measured on a combined endpoint of any readmission or death within 0-7 days and between 8 and 180 days following hospital discharge.
RESULTS
Within 7 days following discharge, 29 (10.5%) patients had an unplanned readmission or death whereas an additional 124 (50.0%) patients reached this combined endpoint within 8-180 days postdischarge. Malnutrition was associated with a significantly higher risk of combined endpoint of readmissions or death both within 7 days (OR 4.57, 95% CI 1.69 to 12.37, P<0.001) and within 8-180 days (OR 1.98, 95% CI 1.19 to 3.28, P=0.007) following discharge and this risk remained significant even after adjustment for other covariates.
CONCLUSIONS
Malnutrition in older patients at the time of hospital admission is a significant predictor of readmission or death both in the very early and in the late periods following hospital discharge. Nutritional state should be included in future risk prediction models.
TRIAL REGISTRATION NUMBER
ACTRN No. 12614000833662; Post-results.
目的
入院时的营养状况与出院后临床结局之间的关系尚未明确。本研究旨在调查老年患者入院时的营养状况是否可预测出院后极早期或晚期的非计划性再入院或死亡。
设计、地点和参与者：该前瞻性研究纳入了 297 名年龄≥60 岁、因躯体疾病就诊于澳大利亚一家三级医院综合内科的患者。入院时采用患者主观整体评估量表（PG-SGA）评估营养状况，根据量表评分将患者分为营养良好（PG-SGA 分级 A）或营养不良（PG-SGA 分级 B 和 C）。采用多变量逻辑回归模型调整已知影响临床结局的其他混杂因素，并确定营养不良是否为出院后 0-7 天（极早期）或 8-180 天（晚期）再入院或死亡的预测因素。
结局测量
营养状况对出院后 0-7 天和 8-180 天内任何再入院或死亡的联合终点的影响进行了测量。
结果
出院后 7 天内，29 例（10.5%）患者发生非计划性再入院或死亡，另外 124 例（50.0%）患者在出院后 8-180 天内达到该联合终点。营养不良与再入院或死亡联合终点的风险显著增加相关，出院后 7 天内（比值比 4.57，95%置信区间 1.69 至 12.37，P<0.001）和 8-180 天内（比值比 1.98，95%置信区间 1.19 至 3.28，P=0.007）均如此，即使在校正其他混杂因素后，这种风险仍然显著。
结论
老年患者入院时的营养不良是出院后极早期和晚期再入院或死亡的显著预测因素。营养状态应纳入未来的风险预测模型。
临床试验注册
ACTRN No. 12614000833662；Post-results。
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