Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days
Impact of declines in nutritional status on outcomes in adult patients hospitalized for more than 7 days
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DOI：
10.1016/s0002-8223(00)00373-4
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发表时间：
2000-11-01
影响因子：
--
通讯作者：
Sheean, PM
中科院分区：
文献类型：
--
作者：
Braunschweig, C;Gomez, S;Sheean, PM
目的探讨住院患者营养状况变化与感染、并发症、住院时间和住院费用之间的关系。设计采用前瞻性观察性研究方法，对某大学医院住院7个月以上的404例非妊娠或哺乳期非精神病患者进行前瞻性观察研究。主要观察指标包括入院和出院时主观综合评估(SGA)评估的营养状况变化、住院天数、住院费用、并发症、住院时间、住院天数、住院天采用多项比较的Tukey调整方法进行统计学分析，检验不同营养变化类别间营养状况变化对连续变量(费用和住院时间)的影响。离散变量用X~1(2)分析进行评估。结果与对照组(入院和出院时营养正常)相比，无论入院时营养状况如何，营养不良患者的住院费用显著高于对照组(28,631美元+/-1,835美元对45,762美元+/-4,021美元)。与对照组相比，无论入院时营养状况如何，营养状况下降的患者发生并发症的几率显著增加。应用/结论患者在住院期间的营养状况下降，无论他们入院时的营养状况如何，都与显著更高的住院费用和更高的并发症可能性相关。执业临床医生应将减少患者营养状况的下降作为优先事项，而不管患者入院时的营养状况如何。
Objective To assess the association between changes in nutritional status in hospitalized patients and the occurrence of infections, complications, length of stay in hospital, and hospital charges.Design A prospective observational study with a retrospective component was conducted over a 7-month interval at a university hospital.Subjects A total of 404 adults (greater than or equal to 18 years old) admitted to the inpatient service for more than 7 days who were not pregnant or lactating and not a psychiatric patient were included.Main outcome measures Major outcome variables included changes in nutritional status as assessed by subjective global assessment (SGA) at hospital admission and discharge, length of stay, hospital charges, complications, and infections.Statistical analysis performed Analysis of variance with a Tukey adjustment for multiple comparisons was used to examine the impact of changes in nutritional status between nutrition change categories for continuous variables (charges and length of stay). Discrete variables were assessed using chi (2) analysis. Logistic regression was used to calculate odds ratios with 95% confidence intervals for the development of complications and infections when compared with the reference group.Results Compared with the reference group (normally nourished at admission and discharge), patients who declined nutritionally, regardless of nutritional status at admission, had significantly higher hospital charges ($28,631 +/-1,835 vs $45,762 +/-4,021). Odds of complications were significantly greater for patients who declined nutritionally, regardless of nutritional status at admission, compared with the reference group.Applications/conclusions Declines in patients' nutritional status while they are hospitalized, regardless of their nutritional status at admission, were associated with significantly higher hospital charges and a higher likelihood of complications. Practicing clinicians should make reducing declines in patients' nutritional status a priority regardless of patients' nutritional status at admission.