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

Eur J Clin Invest. 2016 Jul;46(7):609-18. doi: 10.1111/eci.12637. Epub 2016 May 24.

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.

Keywords: Bioimpedance; hospitalization; malnutrition; mini-nutritional assessment; mortality; phase angle.

Publication types

  • Observational Study

MeSH terms

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