Nutritional Status Predicts Functional Recovery and Adverse Outcomes in Older Adults: A Prospective Cohort Study

IF 9.4 1区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Cachexia Sarcopenia and Muscle Pub Date : 2025-04-15 DOI:10.1002/jcsm.13819

Ludiane Alves do Nascimento, Marlon Juliano Romero Aliberti, Natalia Golin, Erika Suíter, Christian Valle Morinaga, Thiago Junqueira Avelino Silva, Pedro Kallas Curiati

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引用次数: 0

Abstract

Background

Despite the high prevalence of malnutrition in acutely ill older patients, nutritional status is rarely assessed in emergency departments (EDs), and the impact of nutritional risk screening on functional recovery is poorly understood. This study aimed to investigate the association between nutritional parameters and a range of outcomes in older patients admitted through the ED.

Methods

A prospective cohort study was conducted at tertiary hospital, enrolling patients aged 65 years or older between November 2021 and April 2022. We collected data on various patient parameters, including demographics, clinical factors (Charlson Comorbidity Index [CCI], National Early Warning Score 2), nutritional status (Nutritional Risk Screening 2002; Global Leadership Initiative on Malnutrition criteria) and geriatric measures (Clinical Frailty Scale, Katz Index of Independence in Activities of Daily Living [ADL], Lawton and Brody Instrumental ADL, and PRO-AGE vulnerability tool). The primary outcome was functional recovery, and secondary outcomes included nosocomial infection, prolonged length of stay (LoS), in-hospital and postdischarge mortality, and hospital readmissions up to 6 months. Fine–Gray competing risks regression and multivariable logistic regressions were employed and adjusted for age, sex, education, CCI, functional status, LoS and initial allocation to intensive care.

Results

A total of 780 patients (mean age 80 ± 9 years, predominantly male) were included, with 32.2% identified as at nutritional risk and 22.1% diagnosed with malnutrition. Patients with no nutritional risk had a higher significantly functional recovery up to 6 months (79% vs. 66%, sub-HR = 1.28, 95%CI 1.04–1.57, p = 0.029), whereas nutritional risk was independently associated with in-hospital (13% vs. 2%, OR = 4.24, 95%CI 1.53–11.74, p = 0.005) and postdischarge (14% vs. 4%, OR = 2.76, 95%CI 1.17–6.49, p = 0.02) mortality. Finally, malnutrition was independently associated with nosocomial infection (12% vs. 2%, OR = 5.43, 95%CI 2.56–11.5, p < 0.001), prolonged LoS (56% vs. 22%, OR = 2.79, 95%CI 1.84–4.22, p < 0.001) and postdischarge mortality (13% vs. 4%, OR = 2.76, 95%CI 1.36–5.61, p = 0.005).

Conclusions

Nutritional parameters were significant predictors of functional recovery, nosocomial infection, prolonged LoS and mortality in older patients admitted through the ED. Early identification and interventions targeting nutritional deficiencies should be explored to improve outcomes in this vulnerable population.

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营养状况预测老年人功能恢复和不良后果：一项前瞻性队列研究

尽管急性老年患者营养不良的发生率很高，但急诊部门很少评估营养状况，营养风险筛查对功能恢复的影响也知之甚少。本研究旨在探讨通过急诊科入院的老年患者营养参数与一系列结局之间的关系。方法在三级医院进行一项前瞻性队列研究，纳入2021年11月至2022年4月期间65岁或以上的患者。我们收集了各种患者参数的数据，包括人口统计学、临床因素（Charlson共病指数[CCI]、国家预警评分2）、营养状况(2002年营养风险筛查；全球领导倡议营养不良标准)和老年措施（临床虚弱量表，Katz日常生活活动独立性指数[ADL]， Lawton和Brody工具ADL和PRO-AGE脆弱性工具）。主要终点是功能恢复，次要终点包括医院感染、住院时间延长（LoS）、住院和出院后死亡率以及再入院时间长达6个月。采用细灰色竞争风险回归和多变量logistic回归，并对年龄、性别、教育程度、CCI、功能状态、LoS和重症监护初始分配进行调整。结果共纳入780例患者（平均年龄80±9岁，以男性为主），其中32.2%的患者存在营养风险，22.1%的患者诊断为营养不良。无营养风险的患者在6个月内的功能恢复明显更高（79%对66%，亚hr = 1.28, 95%CI 1.04-1.57, p = 0.029），而营养风险与住院（13%对2%，OR = 4.24, 95%CI 1.53-11.74, p = 0.005）和出院后（14%对4%，OR = 2.76, 95%CI 1.17-6.49, p = 0.02）死亡率独立相关。最后，营养不良与医院感染（12%比2%，OR = 5.43, 95%CI 2.56-11.5, p < 0.001）、延长生存期（56%比22%，OR = 2.79, 95%CI 1.84-4.22, p < 0.001）和出院后死亡率（13%比4%，OR = 2.76, 95%CI 1.36-5.61, p = 0.005）独立相关。结论营养参数是急诊科住院老年患者功能恢复、医院感染、长期LoS和死亡率的重要预测因素。应探索针对营养缺乏的早期识别和干预措施，以改善这一弱势群体的预后。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.