Sullivan D H, Walls R C
Geriatric Research Education and Clinical Center, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205, USA.
J Am Coll Nutr. 1995 Feb;14(1):29-36. doi: 10.1080/07315724.1995.10718470.
The primary objective of this study was to assess the interrelationship between protein-energy nutritional status, disease severity, and life-threatening complications in a population of elderly rehabilitation patients.
Three-hundred and fifty randomly selected admissions to Geriatric Rehabilitation Unit of a Veterans Administration hospital were prospectively studied. The average age of the study subjects was 76 years, nearly all (99%) were male, and 75% were white. At admission, each patient completed a comprehensive medical, functional, neuropsychological, socioeconomic, and nutritional assessment. While remaining in the hospital, each subject was monitored on a daily basis for the development of complications.
Of the 96 variables evaluated, the best predictors of developing at least one life-threatening complication were serum albumin, body mass index, the presence of renal disease (i.e. blood urea nitrogen > 30 mg/L), the Katz Index of Activities of Daily Living score, and the amount of weight loss in the year prior to admission. When all of these variables were included in the logistic regression analysis, the final model was highly significant by the -2Log Likelihood Chi-square goodness-of-fit criterion (Chi-square of 64.1 with 5 d.f., p < 0.0001) with a sensitivity of 77%, a specificity of 77% and an overall predictive accuracy of 77%. When the predictive accuracy of the logistic model was tested using a second sample of 110 patients, the model differentiated those who developed a life-threatening complication from those who had not with a sensitivity of 88%, a specificity of 61%, and an overall predictive accuracy of 65%. As indicated by the Chi-square test, these results were significant (p < 0.0001).
Protein-energy undernutrition appears to be a strong independent risk factor for life-threatening morbidity during hospitalization.
本研究的主要目的是评估老年康复患者群体中蛋白质 - 能量营养状况、疾病严重程度和危及生命的并发症之间的相互关系。
对一家退伍军人管理局医院老年康复科的350例随机入选患者进行前瞻性研究。研究对象的平均年龄为76岁，几乎所有患者（99%）为男性，75%为白人。入院时，每位患者都完成了全面的医学、功能、神经心理学、社会经济和营养评估。在住院期间，每天对每位受试者进行并发症发生情况监测。
在评估的96个变量中，发生至少一种危及生命并发症的最佳预测指标是血清白蛋白、体重指数、肾病的存在（即血尿素氮>30mg/L）、日常生活活动能力的Katz指数评分以及入院前一年的体重减轻量。当所有这些变量纳入逻辑回归分析时，根据 -2对数似然卡方拟合优度标准，最终模型具有高度显著性（卡方值为64.1，自由度为5，p<0.0001），敏感性为77%，特异性为77%，总体预测准确率为77%。当使用110例患者的第二个样本测试逻辑模型的预测准确率时，该模型区分发生危及生命并发症的患者和未发生者的敏感性为88%，特异性为61%，总体预测准确率为65%。如卡方检验所示，这些结果具有显著性（p<0.0001）。
蛋白质 - 能量营养不良似乎是住院期间发生危及生命疾病的一个强大独立危险因素。
