Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial
Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial
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DOI：
10.1016/j.clnu.2015.12.010
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发表时间：
2016-02-01
影响因子：
6.3
通讯作者：
Ziegler, Thomas R.
中科院分区：
文献类型：
--
作者：
Deutz, Nicolaas E.;Matheson, Eric M.;Ziegler, Thomas R.
背景：住院营养不良的老年人再入院和死亡的风险很高。目的：评估含有 β-羟基-β-甲基丁酸的高蛋白口服营养补充剂 (HP-HMB) 对营养不良、住院老年人非选择性再入院和死亡率的出院后结果。设计：多中心、随机、安慰剂对照、双盲试验。背景：住院和出院后。患者：年龄较大（> = 65）年）、因充血性心力衰竭、急性心肌梗死、肺炎或慢性阻塞性肺病住院的营养不良（主观总体评估 [SGA] B 级或 C 级）成人。干预措施：标准护理加 HP-HMB (n = 328) 或安慰剂补充剂 (n = 324)，每天 2 份。测量：主要复合终点是出院后 90 天死亡或非选择性再入院的发生率。其他终点包括出院后 30 天和 60 天的死亡或再入院发生率、住院时间 (LOS)、SGA 等级、体重和日常生活活动能力 (ADL)。 结果：HP-HMB (26.8%) 和安慰剂 (31.1%) 之间的主要复合终点相似。 90 天再入院率没有观察到组间差异，但与安慰剂相比，HP-HMB 组的 90 天死亡率显着降低（4.8% vs. 9.7%；相对风险 0.49，95% 置信区间 [CI]，0.27 至 0.90；p = 0.018）。预防 1 例死亡所需治疗的人数为 20.3（95% CI：10.9,121.4）。与安慰剂相比，HP-HMB 在第 90 天时改善营养状况的几率提高（SGA 等级，OR，2.04，95% CI：1.28、3.25，p = 0.009），并且在第 30 天体重增加（p = 0.035）。治疗间的 LOS 和 ADL 相似。局限性：通用性有限；患者代表了选定的住院人群。结论：虽然没有观察到主要复合终点的影响，但与安慰剂相比，HP-HMB 在 90 天的观察期内降低了死亡率并改善了营养状况指数。 (C) 2015 年作者。由爱思唯尔有限公司和欧洲临床营养与代谢学会出版。
Background: Hospitalized, malnourished older adults have a high risk of readmission and mortality.Objective: Evaluation of a high-protein oral nutritional supplement (HP-HMB) containing beta-hydroxy-beta-methylbutyrate on postdischarge outcomes of nonelective readmission and mortality in malnourished, hospitalized older adults.Design: Multicenter, randomized, placebo-controlled, double-blind trial.Setting: Inpatient and posthospital discharge.Patients: Older (>= 65 years), malnourished (Subjective Global Assessment [SGA] class B or C) adults hospitalized for congestive heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease.Interventions: Standard-of-care plus HP-HMB (n = 328) or a placebo supplement (n = 324), 2 servings/day.Measurements: Primary composite endpoint was 90-day postdischarge incidence of death or nonelective readmission. Other endpoints included 30- and 60-day postdischarge incidence of death or readmission, length of stay (LOS), SGA class, body weight, and activities of daily living (ADL).Results: The primary composite endpoint was similar between HP-HMB (26.8%) and placebo (31.1%). No between-group differences were observed for 90-day readmission rate, but 90-day mortality was significantly lower with HP-HMB relative to placebo (4.8% vs. 9.7%; relative risk 0.49, 95% confidence interval [CI], 0.27 to 0.90; p = 0.018). The number-needed-to-treat to prevent 1 death was 20.3 (95% CI: 10.9,121.4). Compared with placebo, HP-HMB resulted in improved odds of better nutritional status (SGA class, OR, 2.04, 95% CI: 1.28, 3.25, p = 0.009) at day 90, and an increase in body weight at day 30 (p = 0.035). LOS and ADL were similar between treatments. Limitations: Limited generalizability; patients represent a selected hospitalized population.Conclusions: Although no effects were observed for the primary composite endpoint, compared with placebo HP-HMB decreased mortality and improved indices of nutritional status during the 90-day observation period. (C) 2015 The Authors. Published by Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.