title: Nutritional risk as predictor for healthcare-associated infection among hospitalized elderly patients in the acute care setting.
abstract: BACKGROUND
  Poor nutritional status is associated with high rates of healthcare-associated infections (HCAIs) among hospitalized elderly patients. Early recognition of patients at risk for HCAIs is important. The Geriatric Nutritional Risk Index (GNRI) is a screening tool able to predict nutrition-related complications.
  
  
  OBJECTIVE
  To examine the use of GNRI as a predictor of HCAIs in the acute care setting.
  
  
  METHODS
  A total of 248 consecutive patients aged >65 years, admitted as emergencies to the medical ward of an acute care hospital, were enrolled. On admission, clinical and laboratory assessment, anthropometric measurements, performance status, and GNRI score estimation were performed. HCAIs were recorded during admission.
  
  
  RESULTS
  On admission, 53.8% of the patients were not at risk, 37.2% at low or medium risk and 8.9% at high risk for nutrition-related complications, as stratified by using the GNRI. During hospitalization 23.7% of the patients developed HCAIs. Patients with HCAIs had higher mortality (P < 0.001) and longer hospital stay (P < 0.001). In multivariate analysis, a performance status >1 [hazard ratio (HR): 2.08; 95% confidence interval (CI): 1.07-4.02; P = 0.03] and diabetes (HR: 2.57; 95% CI: 1.37-4.84; P = 0.003) were associated with increased risk for HCAIs, whereas GNRI score (per unit increase) had a protective effect (HR: 0.97; 95% CI: 0.95-0.99; P = 0.01). Well-nourished patients (GNRI >98) were significantly more likely to remain free from HCAIs during hospitalization (P = 0.003).
  
  
  CONCLUSIONS
  GNRI can accurately stratify hospitalized elderly patients according to risk for developing HCAIs.
authors.affiliation: Infectious Diseases Unit, Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: M N
authors.initials: MN
authors.lastname: Gamaletsou
authors.forename: K-A
authors.initials: KA
authors.lastname: Poulia
authors.forename: D
authors.initials: D
authors.lastname: Karageorgou
authors.forename: M
authors.initials: M
authors.lastname: Yannakoulia
authors.forename: P D
authors.initials: PD
authors.lastname: Ziakas
authors.forename: A
authors.initials: A
authors.lastname: Zampelas
authors.forename: N V
authors.initials: NV
authors.lastname: Sipsas
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015596:Nutrition Assessment; D009752:Nutritional Status; D018570:Risk Assessment