Senior Consultant Physician Flinders Medical Centre and Senior Lecturer Flinders University, Adelaide. PhD candidate Flinders University. Areas of research include malnutrition in acute care, health economics and quality improvement.
Admission Nutritional Status As A Predictor Of Post-Discharge Clinical Outcomes In Older Hospitalized Patients: A Prospective Observational Study
Yogesh Sharma, Flinders Medical Centre, Adelaide
Michelle Miller, Flinders University, Adelaide
Billingsley Kaambwa, Flinders University, Adelaide
Rashmi Shahi, Flinders University, Adelaide
Campbell Thompson, The University of Adelaide, Adelaide
Aims: Malnutrition is widely prevalent in older hospitalized patients.(1) The relationship between admission nutritional status and clinical outcomes following hospital discharge is not well established. This study investigated whether older patients’ nutritional status at admission predicts unplanned readmission or death in the very early or late periods following hospital discharge.
Methods: This study prospectively recruited 297 patients ≥60 years presenting to the General Medicine Department of a tertiary care hospital in Australia. Nutritional status was assessed at admission by using the Patient Generated Subjective Global Assessment (PG-SGA) tool(2) and patients were classified as either nourished (PG-SGA class A) or malnourished (PG-SGA classes B and C). A multivariate logistic regression model was used to adjust for other covariates known to influence clinical outcomes and to determine whether malnutrition is a predictor for early (0-7days) or late (8-180 days) readmission or death following hospital discharge.
Results: Within seven days following discharge, 29 (10.5%) patients had an unplanned readmission or death whereas an additional 124 (50.0%) patients reached this combined endpoint within 8-180 days post-discharge. Malnutrition was associated with a significantly higher risk of combined endpoint of readmissions or death both within seven days (OR 4.57, 95% CI 1.69-12.27, p<0.001) as well within 8-180 days (OR 1.98, 95% CI 1.19-3.28, p=0.007) following discharge and this risk remained significant even after adjustment for other covariates.
Conclusions: Malnutrition in older patients at the time of hospital admission is a significant predictor of readmission or death both in the very early and late periods following hospital discharge. Nutritional state should be included in future risk-prediction models.
1. Sharma Y, Thompson C, Shahi R, Hakendorf P, Miller M. Malnutrition in acutely unwell hospitalized elderly - “The skeletons are still rattling in the hospital closet”. J Nutr. 2017:1-6.
2. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002;56(8):779-85.