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

Gregorio Caimi, Maria Fatima Massenti, Gaspare Parrinello, Silvio Buscemi, John A. Batsis, Sebastiano Pollina Addario, Flavia Costa

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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: χ2 = 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 χ2 = 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.
Lingua originaleEnglish
pagine (da-a)609-618
Numero di pagine10
RivistaEuropean Journal of Clinical Investigation
Volume46
Stato di pubblicazionePublished - 2016

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Hazards
Nutrition Assessment
Mortality
Emergency rooms
Confidence Intervals
Public health
Hand Strength
Proportional Hazards Models
Malnutrition
Italy
Observational Studies
Registries
Hospital Emergency Service
Inpatients
Cohort Studies
Public Health
Survival

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Clinical Biochemistry

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@article{2dc513ad6f9b43c985a060293459df71,
title = "Nutritional predictors of mortality after discharge in elderly patients on a medical ward",
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: χ2 = 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 χ2 = 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.",
author = "Gregorio Caimi and Massenti, {Maria Fatima} and Gaspare Parrinello and Silvio Buscemi and Batsis, {John A.} and {Pollina Addario}, Sebastiano and Flavia Costa",
year = "2016",
language = "English",
volume = "46",
pages = "609--618",
journal = "European Journal of Clinical Investigation",
issn = "0014-2972",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Nutritional predictors of mortality after discharge in elderly patients on a medical ward

AU - Caimi, Gregorio

AU - Massenti, Maria Fatima

AU - Parrinello, Gaspare

AU - Buscemi, Silvio

AU - Batsis, John A.

AU - Pollina Addario, Sebastiano

AU - Costa, Flavia

PY - 2016

Y1 - 2016

N2 - 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: χ2 = 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 χ2 = 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.

AB - 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: χ2 = 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 χ2 = 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.

UR - http://hdl.handle.net/10447/219064

UR - http://www3.interscience.wiley.com/journal/118482631/home

M3 - Article

VL - 46

SP - 609

EP - 618

JO - European Journal of Clinical Investigation

JF - European Journal of Clinical Investigation

SN - 0014-2972

ER -