Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki 317-0077, Japan.
Nutrients. 2020 Dec 23;13(1):26. doi: 10.3390/nu13010026.
The risk of acute functional decline increases with age, and concepts including frailty and post-acute care syndrome have been proposed; however, the effects of the nutritional status currently remain unclear. Patients admitted to the emergency department of Hitachi General Hospital for infectious diseases between April 2018 and May 2019 were included. To identify risk factors for functional decline at discharge, defined as Barthel Index <60, we investigated basic characteristics, such as age, sex, disease severity, the pre-morbid care status, and cognitive impairment, as well as laboratory data on admission, including albumin as a nutritional assessment indicator. In total, 460 surviving patients out of 610 hospitalized for infection were analyzed. In a multivariable logistic regression analysis, factors independently associated with Barthel Index <60 at discharge were age (adjusted OR 1.03, 95%CI 1.01-1.06, = 0.022), serum albumin (adjusted OR: 0.63, 95%CI: 0.41-0.99, = 0.043), and the need for care prior to admission (adjusted OR: 5.92, 95%CI: 3.15-11.15, < 0.001). Hypoalbuminemia on admission in addition to age and the need for care prior to admission were identified as risk factors for functional decline in patients hospitalized for infection. Functional decline did not correlate with the severity of illness.
急性功能下降的风险随着年龄的增长而增加，因此提出了衰弱和急性后综合征等概念；然而，目前营养状况的影响仍不清楚。本研究纳入了 2018 年 4 月至 2019 年 5 月期间因传染病入住日立综合医院急诊科的患者。为了确定出院时功能下降的危险因素（定义为 Barthel 指数<60），我们调查了基本特征，如年龄、性别、疾病严重程度、发病前的护理状况和认知障碍，以及入院时的实验室数据，包括白蛋白作为营养评估指标。总共分析了 610 例因感染住院的 460 例存活患者。在多变量逻辑回归分析中，与出院时 Barthel 指数<60 独立相关的因素有年龄（调整后的比值比 1.03，95%可信区间 1.01-1.06，P=0.022）、血清白蛋白（调整后的比值比：0.63，95%可信区间：0.41-0.99，P=0.043）和入院前的护理需求（调整后的比值比：5.92，95%可信区间：3.15-11.15，P<0.001）。入院时低白蛋白血症加上年龄和入院前的护理需求是感染住院患者功能下降的危险因素。功能下降与疾病严重程度无关。
