title: Nutritional Status and Mortality in the Critically Ill.
abstract: OBJECTIVE
  The association between nutritional status and mortality in critically ill patients is unclear based on the current literature. To clarify this relation, we analyzed the association between nutrition and mortality in a large population of critically ill patients and hypothesized that mortality would be impacted by nutritional status.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Single academic medical center.
  
  
  METHODS
  Six thousand five hundred eighteen adults treated in medical and surgical ICUs between 2004 and 2011.
  
  
  METHODS
  None.
  
  
  RESULTS
  All cohort patients received a formal, in-person, standardized evaluation by a registered dietitian. The exposure of interest, malnutrition, was categorized as nonspecific malnutrition, protein-energy malnutrition, or well nourished and determined by data related to anthropometric measurements, biochemical indicators, clinical signs of malnutrition, malnutrition risk factors, and metabolic stress. The primary outcome was all-cause 30-day mortality determined by the Social Security Death Master File. Associations between nutrition groups and mortality were estimated by bivariable and multivariable logistic regression models. Adjusted odds ratios were estimated with inclusion of covariate terms thought to plausibly interact with both nutrition status and mortality. We used propensity score matching on baseline characteristics to reduce residual confounding of the nutrition status category assignment. In the cohort, nonspecific malnutrition was present in 56%, protein-energy malnutrition was present in 12%, and 32% were well nourished. The 30-day and 90-day mortality rates for the cohort were 19.1% and 26.6%, respectively. Nutritional status is a significant predictor of 30-day mortality following adjustment for age, gender, race, medical versus surgical patient type, Deyo-Charlson index, acute organ failure, vasopressor use, and sepsis: nonspecific malnutrition 30-day mortality odds ratio, 1.17 (95% CI, 1.01-1.37); protein-energy malnutrition 30-day mortality odds ratio, 2.10 (95% CI, 1.70-2.59), all relative to patients without malnutrition. In the matched cohort, the adjusted odds of 30-day mortality in the group of propensity score-matched patients with protein-energy malnutrition was two-fold greater than that of patients without malnutrition.
  
  
  CONCLUSIONS
  In a large population of critically ill adults, an association exists between nutrition status and mortality.
authors.affiliation: 1Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts. 2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 3Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 4Harvard Medical School, Boston, Massachusetts. 5Department of Medicine, Okinawa Hokubu Prefectural Hospital, Okinawa, Japan. 6Department of Medicine, The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital.
authors.forename: Kris M
authors.initials: KM
authors.lastname: Mogensen
authors.forename: Malcolm K
authors.initials: MK
authors.lastname: Robinson
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Casey
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gunasekera
authors.forename: Takuhiro
authors.initials: T
authors.lastname: Moromizato
authors.forename: James D
authors.initials: JD
authors.lastname: Rawn
authors.forename: Kenneth B
authors.initials: KB
authors.lastname: Christopher
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009752:Nutritional Status; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors