Association of nutritional risk and adverse medical outcomes across different medical inpatient populations

Felder, Susan; Lechtenboehmer, Christian; Bally, Martina; Fehr, Rebecca; Deiss, Manuela; Faessler, Lukas; Kutz, Alexander; Steiner, Deborah; Rast, Anna C; Laukemann, Svenja; Kulkarni, Prasad; Stanga, Zeno Giovanni; Haubitz, Sebastian; Huber, Andreas R.; Müller, Beatrice Ursula; Schuetz, Philipp (2015). Association of nutritional risk and adverse medical outcomes across different medical inpatient populations. Nutrition, 31(11-12), pp. 1385-1393. Elsevier 10.1016/j.nut.2015.06.007

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OBJECTIVE The aim of this study was to examine the prevalence of nutritional risk and its association with multiple adverse clinical outcomes in a large cohort of acutely ill medical inpatients from a Swiss tertiary care hospital. METHODS We prospectively followed consecutive adult medical inpatients for 30 d. Multivariate regression models were used to investigate the association of the initial Nutritional Risk Score (NRS 2002) with mortality, impairment in activities of daily living (Barthel Index <95 points), hospital length of stay, hospital readmission rates, and quality of life (QoL; adapted from EQ5 D); all parameters were measured at 30 d. RESULTS Of 3186 patients (mean age 71 y, 44.7% women), 887 (27.8%) were at risk for malnutrition with an NRS ≥3 points. We found strong associations (odds ratio/hazard ratio [OR/HR], 95% confidence interval [CI]) between nutritional risk and mortality (OR/HR, 7.82; 95% CI, 6.04-10.12), impaired Barthel Index (OR/HR, 2.56; 95% CI, 2.12-3.09), time to hospital discharge (OR/HR, 0.48; 95% CI, 0.43-0.52), hospital readmission (OR/HR, 1.46; 95% CI, 1.08-1.97), and all five dimensions of QoL measures. Associations remained significant after adjustment for sociodemographic characteristics, comorbidities, and medical diagnoses. Results were robust in subgroup analysis with evidence of effect modification (P for interaction < 0.05) based on age and main diagnosis groups. CONCLUSION Nutritional risk is significant in acutely ill medical inpatients and is associated with increased medical resource use, adverse clinical outcomes, and impairments in functional ability and QoL. Randomized trials are needed to evaluate evidence-based preventive and treatment strategies focusing on nutritional factors to improve outcomes in these high-risk patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > Forschungsbereich Pathologie > Forschungsgruppe Innere Medizin (discontinued)

UniBE Contributor:

Stanga, Zeno Giovanni; Haubitz, Sebastian and Müller, Beatrice Ursula

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0899-9007

Publisher:

Elsevier

Language:

English

Submitter:

Markus Laimer

Date Deposited:

30 Mar 2016 13:34

Last Modified:

01 Apr 2016 11:09

Publisher DOI:

10.1016/j.nut.2015.06.007

PubMed ID:

26429660

Uncontrolled Keywords:

Length of stay; Mortality; NRS; Nutritional risk screening; Prevalence; Readmission

BORIS DOI:

10.7892/boris.77616

URI:

https://boris.unibe.ch/id/eprint/77616

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