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The relationship between malnutrition risk and clinical outcomes in a cohort of frail older hospital patients.
Clinical Nutrition ESPEN 2016 October
BACKGROUND & AIMS: Malnutrition has an adverse effect on clinical outcomes and frail older people may be at greater risk of malnutrition. The purpose and aims of this study was to investigate the relationship between markers of malnutrition risk and clinical outcomes in a cohort of frail older hospital patients.
METHODS: 78 frail older hospital patients had the following measurements recorded; length of stay (LOS), time to medical fitness for discharge (TMFFD), body mass index (BMI), malnutrition universal screening tool (MUST) and mini-nutritional assessment short-form (MNA-SF) scores, blood urea, C-reactive protein (CRP), albumin, CRP-albumin ratio; and bioelectrical impedance assessment (BIA) measurements (n = 66). Patients were grouped by mortality status 12 months post hospital admission. Grouping by albumin classification was performed (n = 66) whereby, <30 g/l indicated severe malnutrition, 30-34.9, moderate and >35, low. Receiver-operating characteristic (ROC) curve analysis was performed on variables as potential predictors of mortality.
RESULTS: After 12 months, 31% (n = 24) of patients died. LOS was significantly greater in this group (25.0 ± 22.9 vs 15.4 ± 12.7d, P < 0.05). BMI (23.8 ± 4.9 vs 26.4 ± 5.5 kg/m2 ); fat mass (FM) (17.2 ± 9.9 vs 25.5 ± 10.5 kg), fat mass index (FMI) (9.3 ± 4.1 vs 17.9 ± 2.4 kg/m2 ); and MNA-SF score (6.6 ± 2.4 vs 8.6 ± 2.7) were significantly lower (P < 0.05), and urea significantly higher (11.4 ± 8.7 vs 8.8 ± 4.4 mmol/l, P = 0.05). Albumin was typically low across the entire group (30.5 ± 5.9 g/l) and a potential relationship was identified between albumin and MNA-SF score. MNA-SF, FM, and FMI were significant predictors of mortality outcome by ROC curve analysis, whereas MUST was a poor predictor.
CONCLUSION: This study highlights a potential relationship between indicators of malnutrition risk and clinical outcomes in frail older hospital patients which should be studied in larger cohorts with an aim to improve patient care.
METHODS: 78 frail older hospital patients had the following measurements recorded; length of stay (LOS), time to medical fitness for discharge (TMFFD), body mass index (BMI), malnutrition universal screening tool (MUST) and mini-nutritional assessment short-form (MNA-SF) scores, blood urea, C-reactive protein (CRP), albumin, CRP-albumin ratio; and bioelectrical impedance assessment (BIA) measurements (n = 66). Patients were grouped by mortality status 12 months post hospital admission. Grouping by albumin classification was performed (n = 66) whereby, <30 g/l indicated severe malnutrition, 30-34.9, moderate and >35, low. Receiver-operating characteristic (ROC) curve analysis was performed on variables as potential predictors of mortality.
RESULTS: After 12 months, 31% (n = 24) of patients died. LOS was significantly greater in this group (25.0 ± 22.9 vs 15.4 ± 12.7d, P < 0.05). BMI (23.8 ± 4.9 vs 26.4 ± 5.5 kg/m2 ); fat mass (FM) (17.2 ± 9.9 vs 25.5 ± 10.5 kg), fat mass index (FMI) (9.3 ± 4.1 vs 17.9 ± 2.4 kg/m2 ); and MNA-SF score (6.6 ± 2.4 vs 8.6 ± 2.7) were significantly lower (P < 0.05), and urea significantly higher (11.4 ± 8.7 vs 8.8 ± 4.4 mmol/l, P = 0.05). Albumin was typically low across the entire group (30.5 ± 5.9 g/l) and a potential relationship was identified between albumin and MNA-SF score. MNA-SF, FM, and FMI were significant predictors of mortality outcome by ROC curve analysis, whereas MUST was a poor predictor.
CONCLUSION: This study highlights a potential relationship between indicators of malnutrition risk and clinical outcomes in frail older hospital patients which should be studied in larger cohorts with an aim to improve patient care.
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