目的:医院营养不良与更高的医疗费用和更糟糕的预后相关。只有少数前瞻性研究评估了急性住院期间营养状况的趋势,但这些研究受到营养评估之间时间短的限制.这项研究的目的是调查营养状况的变化,医院获得性营养不良(HAM)的发生率,以及入院时间>14天的急性成年患者的相关危险因素和结局。
方法:在布里斯班一家三级医院的两个内科病房和两个外科病房进行了一项前瞻性观察性队列研究,澳大利亚。在基线(第8天)和每周使用主观全局评估进行营养评估直至出院。营养下降定义为入院后>14天,从营养良好到中度/重度营养不良(HAM)或从中度到重度营养不良(进一步下降)的变化。
结果:本研究纳入了130名患者(58.5%为男性;中位年龄67.0岁(IQR24.4),中位住院时间23.5天(IQR14))。在基线,70.8%(92/130)的患者营养良好。营养下降发生在23.8%(31/130),28.3%(26/92)经历HAM。在入院时中度营养不良的患者中(n=30),16%(5/30)持续下降至严重营养不良。从中度和重度营养不良到营养良好的营养状况改善了18.4%(7/38)。在入院的第一周内没有规定正确的营养护理计划是院内营养下降或营养不良的独立预测因素(OR2.3(95%CI1.0-5.1),p=0.039)。院内营养下降与其他院内并发症显著相关(OR3.07(95%CI1.1-8.9),p=0.04)和更长的住院时间(HR0.63(95%CI0.4-0.9),p=0.044)。
结论:这项研究发现急性患者的营养下降率很高,强调住院期间反复进行营养筛查和评估的重要性,以及积极的跨学科营养护理,以治疗或预防营养进一步下降。
OBJECTIVE: Hospital malnutrition is associated with higher healthcare costs and worse outcomes. Only a few prospective studies have evaluated trends in nutritional status during an acute stay, but these studies were limited by the short timeframe between nutrition assessments. The aim of this study was to investigate changes in nutritional status, incidence of hospital-acquired malnutrition (HAM), and the associated risk factors and outcomes in acute adult patients admitted for >14 days.
METHODS: A prospective observational cohort study was conducted in two medical and two surgical wards in a tertiary hospital in Brisbane, Australia. Nutrition assessments were performed using the Subjective Global Assessment at baseline (day eight) and weekly until discharge. Nutritional decline was defined as a change from well-nourished to moderate/severe malnutrition (HAM) or from moderate to severe malnutrition (further decline) >14 days after admission.
RESULTS: One hundred and thirty patients were included in this study (58.5% male; median age 67.0 years (IQR 24.4), median length of stay 23.5 days (IQR 14)). At baseline, 70.8% (92/130) of patients were well-nourished. Nutritional decline occurred in 23.8% (31/130), with 28.3% (26/92) experiencing HAM. Of the patients with moderate malnutrition on admission (n = 30), 16% (5/30) continued to decline to severe malnutrition. Improvement in nutritional status from moderate and severe malnutrition to well-nourished was 18.4% (7/38). Not being prescribed the correct nutrition care plan within the first week of admission was an independent predictor of in-hospital nutritional decline or remaining malnourished (OR 2.3 (95% CI 1.0-5.1), p = 0.039). In-hospital nutritional decline was significantly associated with other hospital-acquired complications (OR 3.07 (95% CI 1.1-8.9), p = 0.04) and longer length of stay (HR 0.63 (95% CI 0.4-0.9), p = 0.044).
CONCLUSIONS: This study found a high rate of nutritional decline in acute patients, highlighting the importance of repeated nutrition screening and assessments during hospital admission and proactive interdisciplinary nutrition care to treat or prevent further nutritional decline.