Nutritional predictors of mortality after discharge in elderly patients on a medical ward.

Silvio Buscemi, John A Batsis, Gaspare Parrinello, Fatima M Massenti, Giuseppe Rosafio, Vittoria Sciascia, Flavia Costa, Sebastiano Pollina Addario, Serena Mendola, Anna M Barile, Vincenza Maniaci, Nadia Rini, Gregorio Caimi

Journal: European journal of clinical investigation 2017;46(7):609-18

PMID: 27112375

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Abstract

BACKGROUND

Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients.

MATERIALS AND METHODS

This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models.

RESULTS

Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01-5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21-6·64; log-rank test: χ(2) = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22-2·81 χ(2) = 8·2; P = 0·004).

CONCLUSIONS

The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup.

Address: Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.; Section of General Internal Medicine at Dartmouth, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.; Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.; Servizio di Ingegneria Clinica, Policlinico 'P. Giaccone', Palermo, Italy.; Dipartimento Attività Sanitarie ed Osservatorio Epidemiologico, Regione Siciliana, Palermo, Italy.

DOI: 10.1111/eci.12637

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MeSH Terms: Age Factors, Aged, Aged, 80 and over, Anthropometry, Cohort Studies, Comorbidity, Coronary Disease, Diabetes Mellitus, Type 2, Electric Impedance, Female, Follow-Up Studies, Hand Strength, Hospitalization, Humans, Hypertension, Italy, Kidney Failure, Chronic, Male, Malnutrition, Middle Aged, Mortality, Nutrition Assessment, Nutritional Status, Patient Discharge, Patients' Rooms, Prognosis, Proportional Hazards Models, Prospective Studies, Risk Factors