Effect of nutritional status on clinical outcome in a population of geriatric rehabilitation patients.
OBJECTIVE
In a geriatric patient, nutritional status (NS), particularly in the case of malnutrition (M), may influence not only clinical results but also achievement of targets expected by geriatric rehabilitation. The aim of this study was to evaluate the effect of nutritional status (NS) on the occurrence of Adverse Clinical Events (ACE) and on mortality in geriatric rehabilitation patients.


METHODS
We retrospectively examined the clinical records of 278 elderly subjects (154 women, 124 men), admitted to a geriatric hospital between September 2000 and December 2001 and evaluated for clinical, functional, cognitive and NS within the first 48 hours of admission. Clinical outcomes (ACE, mortality) were recorded during follow-up. Logistic regression analysis estimated models having mortality or the occurrence of ACE as outcome variables.


RESULTS
Malnutrition was detected upon admission in 56.1% of the sample population. Incidence of ACE in malnourished subjects was higher than that in well-nourished patients (28.2 vs 13.1%). Equally, mortality among malnourished subjects was higher than among those whose NS was normal (23.1 vs 9.8%). The logistic regression models were able to predict: 1) mortality from comorbidity (OR 1.43; 95% CI 1.16-1.78; p=0.001) and NS (OR 2.64; 95% CI 1.29-5.4; p=0.008), and 2) occurrence of ACE from comorbidity (OR 1.69; 95% CI 1.36-2.1; p=0.000), cognitive (OR 1.22; 95% CI 1.11-1.35; p=0.000) and nutritional status (OR 2.38; 95% CI 1.19-4.8; p=0.015).


CONCLUSIONS
NS emerged as the main independent predictor of both mortality and occurrence of ACE. Although most patients fell into the category of mild/moderate (energy) malnutrition (148/156), a mild deterioration of NS, for instance, reduction in triceps skinfold thickness (TSF) seemed to be sufficient to cause an increase in the incidence of ACE and in mortality.
Donini
Lorenzo M
LM
Istituto di Scienza dell'Alimentazione, Università La Sapienza, Roma, Italy. lorenzomaria.donini@uniroma1.it
De Bernardini
Laura
L
De Felice
Maria Rosaria
MR
Savina
Claudia
C
Coletti
Cecilia
C
Cannella
Carlo
C
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D003863:Depression / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D005853:Geriatrics / Q000379:methods / Q000706:statistics & numerical data*; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000534:rehabilitation / Q000628:therapy*; D008609:Mental Status Schedule; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status / Q000502:physiology*; D012189:Retrospective Studies; D012384:Rome; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome