背景:缺乏广泛接受的,用于诊断住院患者营养不良的广泛验证的工具限制了评估营养作为健康输入和结果的整体作用的能力。疾病,和治疗。
目的:本研究旨在评估营养与饮食学会/美国肠外和肠内营养学会(ASPEN)指标诊断营养不良(AAIM)工具的预测有效性,并确定是否可以简化。
方法:一项前瞻性队列研究于2019年8月至2022年9月在美国32家医院进行。在基线,使用AAIM工具对290名成年患者进行了营养不良诊断评估,评估体重减轻,能量摄入不足,皮下脂肪和肌肉损失,水肿,和手的握力。从医疗记录中提取医疗结果:出院后90天内急诊科(ED)就诊和再入院的综合发生率;住院时间(LOS);和医疗保险严重程度疾病相关组(MS-DRG)相对体重(即医疗保健资源利用)。我们使用了多层次,多变量负二项或广义线性回归模型评估营养不良诊断和医疗结果之间的关系。
结果:在调整疾病严重程度和敏锐度以及社会人口统计学特征后,诊断为严重营养不良的个体有较高的ED就诊率和再入院率(发生率比:1.89;95%CI:1.14,3.13;P=0.01),诊断为中度营养不良的个体的LOS延长了25.2%(95%CI:2.0%,53.7%;P=0.03),医疗保健资源利用率提高15.1%(95%CI:1.6%,31.9%;P=0.03)与没有营养不良诊断的个体相比。观察到的关系保持一致时,只考虑营养不良诊断支持至少两个这些指标:体重减轻,皮下脂肪损失,肌肉萎缩,能量摄入不足。
结论:这项多医院研究的结果证实了原始或简化的AAIM工具的预测有效性,并支持其在住院成年患者中的常规使用。该试验在clinicaltrials.gov上注册为NCT03928548(https://classic。
结果:gov/ct2/show/NCT03928548)。
The lack of a widely accepted, broadly validated tool for diagnosing malnutrition in hospitalized patients limits the ability to assess the integral role of nutrition as an input and outcome of health, disease, and treatment.
This
study aimed to evaluate the predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (ASPEN) indicators to diagnose malnutrition (AAIM) tool and determine if it can be simplified.
A prospective cohort
study was conducted from August 2019 to September 2022 with 32 hospitals in United States. At baseline, 290 adult patients were evaluated for a diagnosis of malnutrition using the AAIM tool, which assesses weight loss, inadequate energy intake, subcutaneous fat and muscle loss, edema, and hand grip strength. Healthcare outcomes were extracted from the medical record: composite incidence of emergency department (ED) visits and hospital readmissions within 90 d postdischarge; length of hospital stay (LOS); and Medicare Severity Disease Related Group (MS-DRG) relative weight (i.e., healthcare resource utilization). We used multilevel, multivariable negative binomial or generalized linear regression models to evaluate relationships between malnutrition diagnosis and healthcare outcomes.
After adjusting for disease severity and acuity and sociodemographic characteristics, individuals diagnosed with severe malnutrition had a higher incidence rate of ED visits and hospital readmissions (incidence rate ratio: 1.89; 95% CI: 1.14, 3.13; P = 0.01), and individuals diagnosed with moderate malnutrition had a 25.2% longer LOS (95% CI: 2.0%, 53.7%; P = 0.03) and 15.1% greater healthcare resource utilization (95% CI: 1.6%, 31.9%; P = 0.03) compared with individuals with no malnutrition diagnosis. Observed relationships remained consistent when only considering malnutrition diagnoses supported by at least 2 of these indicators: weight loss, subcutaneous fat loss, muscle wasting, and inadequate energy intake.
Findings from this multihospital
study confirm the predictive validity of the original or simplified AAIM tool and support its routine use for hospitalized adult patients. This
trial was registered at clinicaltrials.gov as NCT03928548 (https://classic.
gov/ct2/show/NCT03928548).