Mailman School of Public Health, Columbia University, New York, New York, USA.
Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
JPEN J Parenter Enteral Nutr. 2020 Feb;44(2):256-264. doi: 10.1002/jpen.1599. Epub 2019 Apr 29.
Standardized diagnostic criteria for malnutrition were developed by the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) in 2012. The criteria as a whole has had little validation, and the effect of underlying condition on the impact of malnutrition has not been well studied. We measured the association between severe malnutrition and hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality among critically ill inpatients.
We analyzed hospital records from 5606 patients whose admission included an ICU stay. Associations between severe malnutrition and LOS and mortality were examined by multivariable linear and logistic regression.
Thirteen percent were diagnosed with severe malnutrition. These had significantly longer hospital LOS (18 [interquartile range 10-35] days vs 8 [5-14] days), total ICU LOS (7 [3-15] days vs 3 [1-6] days) and in-hospital mortality (odds ratio [OR] 2.78, 95% confidence interval [CI] 2.33-3.31), compared with those without severe malnutrition. After adjusting for demographics, we found significant interactions between severe malnutrition and ICU location. Patients with malnutrition in the cardiothoracic surgery ICU experienced the largest increases in hospital LOS (21.10 days, 95% CI 18.58-23.61), ICU LOS (12.14 days, 95% CI 10.41-13.87), and in-hospital mortality (OR 8.78, 95% CI 5.11-15.07).
Critically ill patients diagnosed with severe malnutrition based on the AND/ASPEN diagnostic characteristics experienced longer hospital and ICU LOS and increased mortality. The magnitude of effect of malnutrition was modified by ICU location, underscoring the need to identify the major comorbidities associated with malnutrition.
营养学会/美国肠外与肠内营养学会（AND/ASPEN）于 2012 年制定了营养不良的标准化诊断标准。这些标准总体上验证不足，营养不良对潜在疾病的影响也尚未得到充分研究。我们测量了严重营养不良与危重症住院患者的住院时间（LOS）、重症监护病房（ICU）LOS 和死亡率之间的关系。
我们分析了 5606 名患者的住院记录，这些患者的入院包括 ICU 住院。通过多变量线性和逻辑回归分析严重营养不良与 LOS 和死亡率之间的关系。
13%的患者被诊断为严重营养不良。这些患者的住院 LOS（18 [四分位距 10-35] 天与 8 [5-14] 天）、总 ICU LOS（7 [3-15] 天与 3 [1-6] 天）和院内死亡率（比值比 [OR] 2.78，95%置信区间 [CI] 2.33-3.31）显著高于无严重营养不良的患者。在调整人口统计学因素后，我们发现严重营养不良和 ICU 位置之间存在显著的相互作用。在心胸外科 ICU 中患有营养不良的患者，其住院 LOS（21.10 天，95%CI 18.58-23.61）、ICU LOS（12.14 天，95%CI 10.41-13.87）和院内死亡率（OR 8.78，95%CI 5.11-15.07）增加最大。
根据 AND/ASPEN 诊断特征诊断为严重营养不良的危重症患者经历了更长的住院和 ICU LOS 以及更高的死亡率。营养不良的影响程度受到 ICU 位置的影响，这强调了需要确定与营养不良相关的主要合并症。
