一项涉及 73843 名患者的多中心倾向评分匹配分析，评估营养风险与死亡率、住院时间和再入院率之间的关系。

A multicenter propensity score matched analysis in 73,843 patients of an association of nutritional risk with mortality, length of stay and readmission rates.

机构信息

Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.

Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.

出版信息

Am J Clin Nutr. 2021 Sep 1;114(3):1123-1130. doi: 10.1093/ajcn/nqab135.

DOI:10.1093/ajcn/nqab135

PMID:33987635

Abstract

BACKGROUND

The reported prevalences and effects of nutritional risk vary widely in the literature because of both methodological differences (e.g., screening tools and statistical analyses) and different patient populations.

OBJECTIVE

In this study the authors analyzed in-hospital mortality, 30-d mortality, readmission within 4 mo, and justified length of stay (jLoS) (determined by governmental assessment to justify financial compensation) in hospitalized patients nutritionally at risk compared with hospitalized patients not at risk.

DESIGN

This was a multicenter retrospective cohort study in 6 Belgian hospitals among inpatients in 2018. Propensity score matching was applied, including comorbidity score and exact matching for hospital, age group, sex, type of admission, living situation, and medical specialty.

RESULTS

In total, 73,843 of 85,677 patients were screened at admission, with 16,141 found to have nutritional risk (prevalence of 21.9%). Oncology patients had the highest risk prevalence of 38.3%, whereas patients receiving plastic or reconstructive surgery had a prevalence of 5.2%. Patients nutritionally at risk had higher odds of dying in the hospital (5.1% compared with 3.3%; OR: 1.56; 95% CI: 1.37, 1.76), dying within 30 d of admission (6.8% compared with 4.3%; OR: 1.62; 95% CI: 1.45, 1.81) and being readmitted within 4 mo after discharge (35.5% compared with 32.9%; OR: 1.12; 95% CI: 1.07, 1.18). These differences were consistent across hospitals. The association between being nutritionally at risk and jLoS was ambiguous.

CONCLUSIONS

One out of 5 patients included in this study was nutritionally at risk. Using propensity score matching, higher odds of in-hospital mortality, readmission, and 30-d mortality were observed. In contrast to oft-reported increased length of stay with poor nutrition, propensity matched data for jLoS suggested that this association was less pronounced in this cohort.

摘要

背景

由于方法学差异（例如，筛查工具和统计分析）和不同的患者人群，文献中报道的营养风险的患病率和影响差异很大。

目的

本研究旨在分析营养风险患者与无营养风险患者相比，住院期间的院内死亡率、30 天死亡率、4 个月内再入院率和合理住院时间（由政府评估以确定财务补偿）。

设计

这是 2018 年在比利时 6 家医院进行的一项多中心回顾性队列研究，纳入了住院患者。应用倾向评分匹配，包括共病评分和医院、年龄组、性别、入院类型、居住情况和医疗专业的精确匹配。

结果

共对 85677 例患者中的 73843 例进行了入院筛查，发现 16141 例存在营养风险（患病率为 21.9%）。肿瘤患者的营养风险患病率最高，为 38.3%，而接受整形或重建手术的患者患病率为 5.2%。有营养风险的患者在医院内死亡的可能性更高（5.1%比 3.3%；OR：1.56；95%CI：1.37，1.76），入院后 30 天内死亡的可能性更高（6.8%比 4.3%；OR：1.62；95%CI：1.45，1.81），出院后 4 个月内再入院的可能性更高（35.5%比 32.9%；OR：1.12；95%CI：1.07，1.18）。这些差异在各医院之间是一致的。营养风险与合理住院时间之间的关系并不明确。