营养状况预测老年人的功能恢复和不良结局：一项前瞻性队列研究。

Nutritional Status Predicts Functional Recovery and Adverse Outcomes in Older Adults: A Prospective Cohort Study.

作者信息

do Nascimento Ludiane Alves, Aliberti Marlon Juliano Romero, Golin Natalia, Suíter Erika, Morinaga Christian Valle, Avelino Silva Thiago Junqueira, Curiati Pedro Kallas

机构信息

Department of Nutrition, Hospital Sírio-Libanês, Sao Paulo, Brazil.

Geriatric Emergency Department Research Group (ProAGE), Hospital Sírio-Libanês, Sao Paulo, Brazil.

出版信息

J Cachexia Sarcopenia Muscle. 2025 Apr;16(2):e13819. doi: 10.1002/jcsm.13819.

DOI:10.1002/jcsm.13819

PMID:40234056

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11999727/

Abstract

BACKGROUND

Despite the high prevalence of malnutrition in acutely ill older patients, nutritional status is rarely assessed in emergency departments (EDs), and the impact of nutritional risk screening on functional recovery is poorly understood. This study aimed to investigate the association between nutritional parameters and a range of outcomes in older patients admitted through the ED.

METHODS

A prospective cohort study was conducted at tertiary hospital, enrolling patients aged 65 years or older between November 2021 and April 2022. We collected data on various patient parameters, including demographics, clinical factors (Charlson Comorbidity Index [CCI], National Early Warning Score 2), nutritional status (Nutritional Risk Screening 2002; Global Leadership Initiative on Malnutrition criteria) and geriatric measures (Clinical Frailty Scale, Katz Index of Independence in Activities of Daily Living [ADL], Lawton and Brody Instrumental ADL, and PRO-AGE vulnerability tool). The primary outcome was functional recovery, and secondary outcomes included nosocomial infection, prolonged length of stay (LoS), in-hospital and postdischarge mortality, and hospital readmissions up to 6 months. Fine-Gray competing risks regression and multivariable logistic regressions were employed and adjusted for age, sex, education, CCI, functional status, LoS and initial allocation to intensive care.

RESULTS

A total of 780 patients (mean age 80 ± 9 years, predominantly male) were included, with 32.2% identified as at nutritional risk and 22.1% diagnosed with malnutrition. Patients with no nutritional risk had a higher significantly functional recovery up to 6 months (79% vs. 66%, sub-HR = 1.28, 95%CI 1.04-1.57, p = 0.029), whereas nutritional risk was independently associated with in-hospital (13% vs. 2%, OR = 4.24, 95%CI 1.53-11.74, p = 0.005) and postdischarge (14% vs. 4%, OR = 2.76, 95%CI 1.17-6.49, p = 0.02) mortality. Finally, malnutrition was independently associated with nosocomial infection (12% vs. 2%, OR = 5.43, 95%CI 2.56-11.5, p < 0.001), prolonged LoS (56% vs. 22%, OR = 2.79, 95%CI 1.84-4.22, p < 0.001) and postdischarge mortality (13% vs. 4%, OR = 2.76, 95%CI 1.36-5.61, p = 0.005).

CONCLUSIONS

Nutritional parameters were significant predictors of functional recovery, nosocomial infection, prolonged LoS and mortality in older patients admitted through the ED. Early identification and interventions targeting nutritional deficiencies should be explored to improve outcomes in this vulnerable population.

摘要

背景

尽管急性病老年患者中营养不良的发生率很高，但急诊科很少评估营养状况，而且营养风险筛查对功能恢复的影响也知之甚少。本研究旨在调查通过急诊科收治的老年患者营养参数与一系列结局之间的关联。

方法

在一家三级医院进行了一项前瞻性队列研究，纳入2021年11月至2022年4月期间年龄在65岁及以上的患者。我们收集了各种患者参数的数据，包括人口统计学、临床因素（查尔森合并症指数[CCI]、国家早期预警评分2）、营养状况（营养风险筛查2002；全球营养不良领导倡议标准）和老年评估指标（临床衰弱量表、卡茨日常生活活动能力独立指数[ADL]、劳顿和布罗迪工具性ADL以及PRO-AGE脆弱性工具）。主要结局是功能恢复，次要结局包括医院感染、住院时间延长、住院期间和出院后死亡率以及6个月内的再次入院。采用Fine-Gray竞争风险回归和多变量逻辑回归，并对年龄、性别、教育程度、CCI、功能状态、住院时间和重症监护的初始分配进行了调整。

结果

共纳入780例患者（平均年龄80±9岁，男性居多），其中32.2%被确定存在营养风险，22.1%被诊断为营养不良。无营养风险的患者在6个月内功能恢复明显更高（79%对66%，亚风险比=1.28，95%置信区间1.04-1.57，p=0.029），而营养风险与住院期间（13%对2%，比值比=4.24，95%置信区间1.53-11.74，p=0.005）和出院后（14%对4%，比值比=2.76，95%置信区间1.17-6.49，p=0.02）死亡率独立相关。最后，营养不良与医院感染（12%对2%，比值比=5.43，95%置信区间2.56-11.5，p<0.001）、住院时间延长（56%对22%，比值比=2.79，95%置信区间1.84-4.22，p<0.001）和出院后死亡率（13%对4%，比值比=2.76，95%置信区间1.36-5.61，p=0.005）独立相关。