Reduced mortality risk in malnourished hospitalized older adult patients with COPD treated with a specialized oral nutritional supplement: Sub-group analysis of the NOURISH study
Reduced mortality risk in malnourished hospitalized older adult patients with COPD treated with a specialized oral nutritional supplement: Sub-group analysis of the NOURISH study
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DOI：
10.1016/j.clnu.2020.08.031
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发表时间：
2021-03-01
影响因子：
6.3
通讯作者：
Jonnalagadda, Satya S.
中科院分区：
文献类型：
--
作者：
Deutz, Nicolaas E.;Ziegler, Thomas R.;Jonnalagadda, Satya S.
背景：住院、营养不良的老年慢性阻塞性肺疾病（COPD）患者再入院和死亡的风险升高。目的：来自滋养研究队列的事后亚组分析检查了含有HMB （HP-HMB）的高蛋白口服营养补充剂（ONS）对营养不良的住院COPD老年人的影响，并确定预后的预测因素。方法：滋养研究（n = 652）是一项多中心、随机、安慰剂对照、双盲试验。慢性阻塞性肺病亚组（n = 214）包括住院、营养不良（基于主观整体评估）、老年人（年龄在65岁以下），入院诊断为慢性阻塞性肺病的患者接受标准治疗加HP-HMB （n = 109）或标准治疗加安慰剂补充（n = 105），规定从入院3天（基线）到出院后90天每天2份。主要研究终点是出院后90天内死亡或非选择性再入院发生率的复合终点，而次要终点包括手部握力、体重和营养生物标志物随时间的变化。分类结果采用Cochran-Mantel-Haenszel检验，纵向资料采用重复测量协方差分析；通过协方差分析得出与基线的变化。p值< 0.05认为有统计学意义。采用多元逻辑回归对主要结局和成分的预测因子进行建模。结果：在COPD患者中，30,60和90天的住院再入院率没有差异，但与安慰剂相比，HP-HMB补充组30,60和90天的死亡风险约低71% （1.83%,2.75%,2.75% vs. 6.67%， 9.52%和10.48%,p = 0.0395, 0.0193, 0.0113，分别对应）。在COPD患者中，与安慰剂相比，从出院到第30天，摄入HP-HMB导致了手握力显著增加（+1.56 kg vs -0.34 kg, p = 0.0413）；从基线到出院时体重增加（0.66 kg vs -0.01 kg, p < 0.05），血液营养生物标志物浓度改善。这些COPD患者的死亡、再入院或复合终点的多因素logistic回归预测因子显示，严重营养不良（p = 0.0191）、格拉斯哥预后评分（GPS）评分为1或2的参与者再入院或死亡的几率具有统计学意义（p = 0.0227）。结论：在营养不良的慢性阻塞性肺疾病住院患者中，在出院后90天内补充HP-HMB可显著降低死亡风险，改善握力、体重和营养生物标志物。这一事后亚组分析强调了早期识别营养风险的重要性。老年营养不良COPD患者入院后和出院后继续给予高蛋白ONS。(c) 2020爱思唯尔有限公司和欧洲临床营养与代谢学会。版权所有。
Background: Hospitalized, malnourished older adults with chronic obstructive pulmonary disease (COPD) have an elevated risk of readmission and mortality.Objective: Post-hoc, sub-group analysis from the NOURISH study cohort examined the effect of a high protein oral nutritional supplement (ONS) containing HMB (HP-HMB) in malnourished, hospitalized older adults with COPD and to identify predictors of outcomes.Methods: The NOURISH study (n = 652) was a multicenter, randomized, placebo-controlled, doubleblind trial. The COPD subgroup (n = 214) included hospitalized, malnourished (based on Subjective Global Assessment), older adults (>65 y), with admission diagnosis of COPD who received either standard-of-care plus HP-HMB (n = 109) or standard-of-care and a placebo supplement (n = 105) prescribed 2 servings/day from within 3 days of hospital admission (baseline) and up to 90 days after discharge. The primary study outcome was a composite endpoint of incidence of death or non-elective readmission up to 90-day post-discharge, while secondary endpoints included changes in hand-grip strength, body weight, and nutritional biomarkers over time. Categorical outcomes were analyzed using Cochran-Mantel-Haenszel tests, longitudinal data by repeated measures analysis of covariance; and changes from baseline by analysis of covariance. p-values < 0.05 were considered statistically significant. Multivariate logistic regression was used to model predictors of the primary outcome and components. Results: In patients with COPD, 30, 60, and 90-day hospital readmission rate did not differ, but in contrast, 30, 60, and 90-day mortality risk was approximately 71% lower with HP-HMB supplementation relative to placebo (1.83%, 2.75%, 2.75% vs. 6.67%, 9.52% and 10.48%, p = 0.0395, 0.0193, 0.0113, resp.). In patients with COPD, compared to placebo, intake of HP-HMB resulted in a significant increase in handgrip strength (+1.56 kg vs.-0.34 kg, p = 0.0413) from discharge to day 30; increased body weight from baseline to hospital discharge (0.66 kg vs.-0.01 kg, p < 0.05) and, improvements in blood nutritional biomarker concentrations. The multivariate logistic regression predictors of the death, readmission or composite endpoints in these COPD patients showed that participants who were severely malnourished (p = 0.0191) and had a Glasgow prognostic score (GPS) Score of 1 or 2 had statistically significant odds of readmission or death (p = 0.0227). Conclusions: Among malnourished, hospitalized patients with COPD, supplementation with HP-HMB was associated with a markedly decreased mortality risk, and improved handgrip strength, body weight, and nutritional biomarkers within a 90-day period after hospital discharge. This post-hoc, subgroup analysis highlights the importance of early identification of nutritional risk and & nbsp;administration of high-protein ONS in older, malnourished patients with COPD after hospital admission and continuing after hospital discharge.(c) 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.