Malnutrition, Critical Illness Survivors and post-discharge outcomes: a cohort study
Abstract
Background We hypothesized that pre-existing malnutrition in patients who survived critical care would be associated with adverse outcomes following hospital discharge. Methods We performed an observational cohort study in one Academic Medical Center in Boston. We studied 23,575 patients, age ≥ 18 years, who received critical care between 2004 and 2011 and survived hospitalization. Results The exposure of interest was malnutrition determined at ICU admission by a registered dietitian using clinical judgment and on data related to unintentional weight loss, inadequate nutrient intake, and wasting of muscle mass and/or subcutaneous fat. The primary outcome was 90-day post-discharge mortality. Secondary outcome was unplanned 30-day hospital readmission. Adjusted odds ratios were estimated by logistic regression models adjusted for age, race, gender, Deyo-Charlson Index, surgical ICU, sepsis, and acute organ failure. In the cohort, the absolute risk of 90-day post-discharge mortality was 5.9%, 11.7%, 15.8% and 21.9% in patients without malnutrition, those at risk of malnutrition, non-specific malnutrition and protein-energy malnutrition respectively. The odds of 90-day post-discharge mortality in patients at risk of malnutrition, non-specific malnutrition and protein-energy malnutrition fully adjusted were 1.77 (95%CI, 1.23–2.54), 2.51 (95%CI, 1.36–4.62) and 3.72 (95%CI, 2.16–6.39) respectively, relative to patients without malnutrition. Further, the presence of malnutrition is…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 23,575 participants or records.
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