Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
JPEN J Parenter Enteral Nutr. 2018 Jul;42(5):892-897. doi: 10.1002/jpen.1021. Epub 2018 Jan 31.
Few studies have compared malnutrition identified by the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) consensus criteria with clinical outcomes. Our goal was to compare 30-day readmissions (primary outcome), hospital mortality, length of stay (LOS) in survivors, and time to discharge alive (TDA) in all patients assessed as malnourished or not malnourished using these criteria in fiscal year 2015. We hypothesized more frequent admissions, greater mortality, longer LOS, and less likely shorter TDA in the malnourished patients.
Demographic variables, clinical outcomes, and malnutrition diagnosis for all initial patient admissions were obtained retrospectively from the electronic medical record. Logistic regression was used to compare categorical and Cox proportional hazards for TDA in unadjusted and adjusted (age, sex, race, medical/surgical admission, Charlson Comorbidity Index) models.
Of the 3907 patients referred for nutrition assessment, 66.88% met criteria for moderate or severe malnutrition. Malnourished patients were older (61 vs 58 years, P < .0001), and survivors had longer LOS (15 vs 12 days, P = .0067) and were more likely to be readmitted within 30 days (40% vs 23%, P < .0001). In adjusted models, 30-day readmissions (odds ratio [OR] 2.13, 95% confidence interval [CI] 1.82-2.48) and hospital mortality (OR 1.47, 95% CI 1.0-1.99) were increased, and the likelihood of earlier TDA was reduced (hazard ratio [HR] 0.55, 95% CI 0.44-0.77) in those who had >2-day stay.
The AND/ASPEN criteria identified malnourished patients in a high-risk population who had more adverse clinical outcomes. Further studies are needed to determine whether optimal provision of nutrition support can improve these outcomes.
很少有研究比较过由营养与饮食学会/美国肠外与肠内营养学会（AND/ASPEN）共识标准确定的营养不良与临床结果。我们的目标是比较在 2015 财年使用这些标准评估为营养不良或非营养不良的所有患者的 30 天再入院率（主要结果）、住院死亡率、幸存者的住院时间（LOS）和存活出院时间（TDA）。我们假设营养不良患者的入院频率更高、死亡率更高、LOS 更长，且 TDA 更不可能缩短。
从电子病历中回顾性获取所有初始患者入院的人口统计学变量、临床结果和营养不良诊断。使用逻辑回归比较未调整和调整（年龄、性别、种族、内科/外科入院、Charlson 合并症指数）模型中 TDA 的分类和 Cox 比例风险。
在被转介进行营养评估的 3907 名患者中，66.88%符合中度或重度营养不良标准。营养不良患者年龄更大（61 岁 vs 58 岁，P<0.0001），幸存者的 LOS 更长（15 天 vs 12 天，P=0.0067），且在 30 天内再入院的可能性更高（40% vs 23%，P<0.0001）。在调整后的模型中，30 天再入院率（优势比[OR]2.13，95%置信区间[CI]1.82-2.48）和住院死亡率（OR 1.47，95%CI 1.0-1.99）增加，而 TDA 提前的可能性降低（风险比[HR]0.55，95%CI 0.44-0.77），这与>2 天的住院时间相关。
AND/ASPEN 标准确定了高危人群中的营养不良患者，这些患者的临床结果更差。需要进一步的研究来确定是否提供最佳的营养支持可以改善这些结果。
