Grant Hiura1, Benjamin Lebwohl2, David S Seres2,3. 1. Mailman School of Public Health, Columbia University, New York, New York, USA. 2. Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA. 3. Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York, USA.
Abstract
BACKGROUND: Standardized diagnostic criteria for malnutrition were developed by the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) in 2012. The criteria as a whole has had little validation, and the effect of underlying condition on the impact of malnutrition has not been well studied. We measured the association between severe malnutrition and hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality among critically ill inpatients. METHODS: We analyzed hospital records from 5606 patients whose admission included an ICU stay. Associations between severe malnutrition and LOS and mortality were examined by multivariable linear and logistic regression. RESULTS: Thirteen percent were diagnosed with severe malnutrition. These had significantly longer hospital LOS (18 [interquartile range 10-35] days vs 8 [5-14] days), total ICU LOS (7 [3-15] days vs 3 [1-6] days) and in-hospital mortality (odds ratio [OR] 2.78, 95% confidence interval [CI] 2.33-3.31), compared with those without severe malnutrition. After adjusting for demographics, we found significant interactions between severe malnutrition and ICU location. Patients with malnutrition in the cardiothoracic surgery ICU experienced the largest increases in hospital LOS (21.10 days, 95% CI 18.58-23.61), ICU LOS (12.14 days, 95% CI 10.41-13.87), and in-hospital mortality (OR 8.78, 95% CI 5.11-15.07). CONCLUSION: Critically ill patients diagnosed with severe malnutrition based on the AND/ASPEN diagnostic characteristics experienced longer hospital and ICU LOS and increased mortality. The magnitude of effect of malnutrition was modified by ICU location, underscoring the need to identify the major comorbidities associated with malnutrition.
BACKGROUND: Standardized diagnostic criteria for malnutrition were developed by the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) in 2012. The criteria as a whole has had little validation, and the effect of underlying condition on the impact of malnutrition has not been well studied. We measured the association between severe malnutrition and hospital length of stay (LOS), intensive care unit (ICU) LOS, and mortality among critically ill inpatients. METHODS: We analyzed hospital records from 5606 patients whose admission included an ICU stay. Associations between severe malnutrition and LOS and mortality were examined by multivariable linear and logistic regression. RESULTS: Thirteen percent were diagnosed with severe malnutrition. These had significantly longer hospital LOS (18 [interquartile range 10-35] days vs 8 [5-14] days), total ICU LOS (7 [3-15] days vs 3 [1-6] days) and in-hospital mortality (odds ratio [OR] 2.78, 95% confidence interval [CI] 2.33-3.31), compared with those without severe malnutrition. After adjusting for demographics, we found significant interactions between severe malnutrition and ICU location. Patients with malnutrition in the cardiothoracic surgery ICU experienced the largest increases in hospital LOS (21.10 days, 95% CI 18.58-23.61), ICU LOS (12.14 days, 95% CI 10.41-13.87), and in-hospital mortality (OR 8.78, 95% CI 5.11-15.07). CONCLUSION:Critically illpatients diagnosed with severe malnutrition based on the AND/ASPEN diagnostic characteristics experienced longer hospital and ICU LOS and increased mortality. The magnitude of effect of malnutrition was modified by ICU location, underscoring the need to identify the major comorbidities associated with malnutrition.
Authors: Cristina Martins; Simone L Saeki; Marcelo Mazza do Nascimento; Fernando M Lucas Júnior; Ana Maria Vavruk; Christiane L Meireles; Sandra Justino; Denise Mafra; Estela Iraci Rabito; Maria Eliana Madalozzo Schieferdecker; Letícia Fuganti Campos; Denise P J van Aanholt; Ana Adélia Hordonho; Marcia Samia Pinheiro Fidelix Journal: J Bras Nefrol Date: 2021 Apr-Jun