title: Accuracy of nutritional assessment tools for predicting adverse hospital outcomes.
abstract: OBJECTIVE
  The ability of nutritional status assessment methods to predict clinical outcomes in hospitalized patients has not been completely evaluated. This study compared the accuracy of traditionally used nutritional tools and parameters in predicting death, infection, and length of hospital stay (LOS) in hospitalized adults.
  
  
  METHODS
  Patients admitted at clinical and surgical wards were evaluated by body mass index, percentage of weight loss, Subjective Global Assessment, albumin, lymphocyte count, and followed until discharge. Clinical outcomes considered were in-hospital death, infection, and LOS. Overall accuracy of each method to predict these outcomes was assessed from ROC curves and C-statistic.
  
  
  RESULTS
  Among 434 patients evaluated, 51% had a prolonged LOS, 23% developed infection, and 7.8% died during hospitalization. In univariate analysis, serum albumin was the strongest predictive parameter for death (Cstatistic: 0.77; CI95%: 0.69-0.86) and hospital infection (C-statistic: 0.67; CI95%: 0.61-0.74). For longer stay, lymphocyte count (C-statistic: 0.60; CI95%: 0.55-0.65) emerged as the most predictive variable. After adjustment for non-surgical hospitalization and cancer diagnosis, weight loss > 5% (OR: 1.58; CI95%: 1.06-3.35), and serum albumin < 3.5 g/dL (OR: 2.40; CI95%: 1.46-3.94) were associated to LOS. Albumin was the only independent variable related to infection (OR: 5.01; CI95%: 3.06-8.18) and, for hospital death, albumin (OR: 7.20; CI95%: 3.39-15.32) adjusted for age (OR: 1.03; CI95%: 1.01-1.06).
  
  
  CONCLUSIONS
  Nutritional assessment methods evaluated were weakly predictors of hospital outcomes. Except for low serum albumin, isolated use of these methods adds little information in identifying the effect of nutritional status on clinically relevant outcomes.
authors.affiliation: Department of Nutrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. mbeghetto@hcpa.ufrgs.br
authors.forename: M G
authors.initials: MG
authors.lastname: Beghetto
authors.forename: V C
authors.initials: VC
authors.lastname: Luft
authors.forename: E D
authors.initials: ED
authors.lastname: Mello
authors.forename: C A
authors.initials: CA
authors.lastname: Polanczyk
mesh_terms: D015992:Body Mass Index; D005260:Female; D006760:Hospitalization; D006801:Humans; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011379:Prognosis; D015203:Reproducibility of Results; D012709:Serum Albumin / Q000032:analysis; D015431:Weight Loss
chemical_list: D012709:Serum Albumin