title: Utilizing multiple methods to classify malnutrition among elderly patients admitted to the medical and surgical intensive care units (ICU).
abstract: OBJECTIVE
  The nutritional status of elderly patients requiring ICU admission is largely unknown. This study evaluated the prevalence of malnutrition in elderly patients (>65 years) admitted to the surgical and medical ICUs, agreement between assessment techniques and associations between malnutrition and adverse outcomes.
  
  
  METHODS
  For this prospective cohort, nutritional status was classified concurrently using the Mini Nutrition Assessment (MNA), Subjective Global Assessment (SGA), Nutrition Risk Score 2002 (NRS 2002) and MNA-short form (MNA-SF). Demographic and relevant medical information were collected from the medical record prior to the nutrition interview and/or following hospital discharge. Descriptive statistics, inter-rater agreement and regression analyses were conducted.
  
  
  RESULTS
  The average patient was 74.2 (±6.8) years of age with a mean APACHE II score of 11.9 (±3.6). Malnutrition was prevalent in 23-34% of patients (n = 260) with excellent agreement between raters. Compared to MNA, NRS 2002 had the highest sensitivity, while SGA and MNA-SF had higher specificity. Malnutrition at ICU admission was associated with longer hospital LOS, a lower propensity for being discharged home and a greater need for hospice care or death at discharge (all p values <0.05). These relationships were diminished when controlling for severity of illness.
  
  
  CONCLUSIONS
  Future work in this elderly population needs to explore the role of disease acuity, inflammation and body composition in the nutrition assessment process and in the examination of outcomes.
authors: University of Illinois at Chicago, Institute for Health Policy and Research, M/C 275, 1747 West Roosevelt Road, Chicago, IL 60608, USA. Electronic address: psheea1@uic.edu.
authors: Patricia M
authors: PM
authors: Sheean
authors: Sarah J
authors: SJ
authors: Peterson
authors: Yimin
authors: Y
authors: Chen
authors: Dishan
authors: D
authors: Liu
authors: Omar
authors: O
authors: Lateef
authors: Carol A
authors: CA
authors: Braunschweig
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002641:Chicago / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D013502:General Surgery; D015577:Geriatric Assessment; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units; D007388:Internal Medicine; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D015596:Nutrition Assessment; D015995:Prevalence; D011446:Prospective Studies; D012306:Risk; D012680:Sensitivity and Specificity
keywords: Elderly; Intensive care unit; Malnutrition; Mini nutrition assessment; Nutrition risk score 2002; Nutritional status; Subjective global assessment