Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge.
BACKGROUND
The importance of undernutrition as a determinant of postdischarge mortality among hospitalized elderly people remains controversial. The purpose of this study was to investigate this issue.


METHODS
The study included 660 elderly patients (85% white, 98% men, average age 73 +/- 6 years) discharged from a university-affiliated Department of Veterans Affairs Hospital, who were followed for 1 year. Associations between patient characteristics at hospital discharge and mortality were identified utilizing Cox Proportional Hazards Regression analysis.


RESULTS
In the year following hospital discharge, 85 subjects (13%) died. After adjusting for illness severity (Acute Physiology and Chronic Health Evaluation II score) and functional status (Katz Index of Activities of Daily Living score), a body mass index (BMI) </=20 kg/m(2) was strongly associated with mortality (adjusted relative risk, [95% confidence interval] 1.83 [1.17-2.85]), as was more than 10% weight loss in the prior year (2.31 [1.35-3.94]), and weight as percent of usual weight (WPU) </=85% (1.78 [1.14-2.77]). Albumin </=30 g/l was only weakly associated with mortality (1.10 [0.67-1.81]). When all of the putative nutrition variables were included in a multivariable analysis with the two control variables, only BMI followed by WPU </=85% entered the model. Utilizing this model, the predicted probabilities of death at 1 year were calculated for the study subjects and for a hypothetical group of patients who were identical to the study subjects except they were assigned a BMI of 28 kg/m(2) and their WPU was 100%. Compared to 24% of the actual subjects, only 7% of the hypothetical well-nourished patients would have been classified as being at high risk for mortality (a 71% relative reduction).


CONCLUSIONS
Older patients who have evidence of chronic body mass depletion are at significantly increased risk of mortality within the year following hospital discharge.
Liu
Longjian
L
Geriatrics Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock 72205, USA.
Bopp
Melinda M
MM
Roberson
Paula K
PK
Sullivan
Dennis H
DH
D018806:APACHE; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D015415:Biomarkers / Q000032:analysis; D015992:Body Mass Index; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D009026:Mortality; D009748:Nutrition Disorders / Q000150:complications / Q000175:diagnosis; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis
D015415:Biomarkers