Sullivan D H, Walls R C
Geriatric Research Education and Clinical Center, John L. McClellan Memorial Veterans Hospital and Department of Geriatrics, University of Arkansas for Medical Sciences, Little Rock 72205, USA.
J Am Coll Nutr. 1998 Dec;17(6):571-8. doi: 10.1080/07315724.1998.10718805.
The primary objective was to determine whether protein-energy undernutrition among elderly patients discharged from the hospital remains a significant risk factor for mortality beyond 1 year.
Prospective Survey (cohort study).
Outpatient follow-up of patients discharged from a Geriatric Rehabilitation Unit (GRU) of a Veterans Administration hospital.
Of 350 randomly selected admissions to the GRU, 322 were discharged alive from the hospital. These 322 patients represented the study population of whom 99% were male, and 75% were white. The average age of the study patients was 76 (range 58 to 102) years.
At admission and again at discharge, each patient completed a comprehensive medical, functional, neuro-psychological, socioeconomic, and nutritional assessment. Subsequent to discharge, each subject was tracked for an average of 6 years. In addition to including serum albumin and other putative nutrition indicators in the data set, a "nutrition-risk" indicator variable was created. Subjects were stratified into the nutrition "high-risk" group if their albumin was less than 30 g/L or BMI was less than 19; and, "low-risk" group if albumin was equal to or greater than 35 g/L and BMI equal to or greater than 22. All others represented the "moderate-risk" group.
Within the 6-year post-hospital-discharge follow-up period, 237 study subjects (74%) died. Based on the Cox proportional hazards survival model, the variable most strongly associated with mortality was discharge "nutrition-risk" followed by the Katz Index of ADL Score, diagnosis of congestive heart failure, discharge location (home vs. institution), age, and marital status. Within the first 4.5 years of follow-up, the relationship between "nutrition-risk" and mortality remained constant. After 4.5 years, the strength of the correlation began to diminish.
Among the elderly, protein-energy undernutrition present at hospital discharge appears to be a strong independent risk factor for mortality during the subsequent 4.5 years or longer.
主要目的是确定出院的老年患者中蛋白质能量营养不良是否仍是1年以上死亡率的重要危险因素。
前瞻性调查（队列研究）。
退伍军人管理局医院老年康复科出院患者的门诊随访。
在随机选择入住老年康复科的350例患者中，322例出院时存活。这322例患者构成了研究人群，其中99%为男性，75%为白人。研究患者的平均年龄为76岁（范围58至102岁）。
入院时和出院时，每位患者均完成了全面的医学、功能、神经心理、社会经济和营养评估。出院后，对每位受试者平均随访6年。除了在数据集中纳入血清白蛋白和其他假定的营养指标外，还创建了一个“营养风险”指标变量。如果受试者的白蛋白低于30 g/L或体重指数（BMI）低于19，则将其分层为营养“高风险”组；如果白蛋白等于或高于35 g/L且BMI等于或高于22，则为“低风险”组。所有其他患者代表“中度风险”组。
在出院后6年的随访期内，237例研究对象（74%）死亡。基于Cox比例风险生存模型，与死亡率最密切相关的变量是出院时的“营养风险”，其次是Katz日常生活活动能力指数评分、充血性心力衰竭诊断、出院地点（家庭与机构）、年龄和婚姻状况。在随访的前4.5年中，“营养风险”与死亡率之间的关系保持不变。4.5年后，相关性强度开始减弱。
在老年人中，出院时存在的蛋白质能量营养不良似乎是随后4.5年或更长时间内死亡的一个强有力的独立危险因素。
