Nutritional predictors of mortality after discharge in elderly patients on a medical ward.
BACKGROUND
Malnutrition in elderly inpatients hospitalized on medical wards is a significant public health concern. The aim of this study was to investigate nutritional markers as mortality predictors following discharge in hospitalized medical elderly patients.


METHODS
This is a prospective observational cohort study with follow-up of 48 months. Two hundred and twenty-five individuals aged 60 and older admitted from the hospital emergency room in the past 48 h were investigated at the medical ward in the University hospital in Palermo (Italy). Anthropometric and clinical measurements, Mini-nutritional Assessment (MNA) questionnaire, bioelectrical (BIA) phase angle (PA), grip strength were obtained all within 48 h of admission. Mortality data were verified by means of mortality registry and analysed using Cox-proportional hazard models.


RESULTS
Ninety (40%) participants died at the end of follow-up. There were significant relationships between PA, MNA score, age and gender on mortality. Patients in the lowest tertile of PA (< 4·6°) had higher mortality estimates [I vs II tertile: hazard ratio (HR) = 3·40; 95% confidence interval (CI): 2·01-5·77; II vs III tertile: HR = 3·83; 95% CI: 2·21-6·64; log-rank test: χ(2) = 43·6; P < 0·001]. Similarly, the survival curves demonstrated low MNA scores (< 22) were associated with higher mortality estimates (HR = 1·85; 95% CI: 1·22-2·81 χ(2) = 8·2; P = 0·004).


CONCLUSIONS
The MNA and BIA-derived phase angle are reasonable tools to identify malnourished patients at high mortality risk and may represent useful markers in intervention trials in this high-risk subgroup.
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Silvio
http://orcid.org/0000-0003-0730-7649
S
Buscemi
Section of General Internal Medicine at Dartmouth, The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
John A
JA
Batsis
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Gaspare
G
Parrinello
Dipartimento di Scienze per la Promozione della Salute e Materno Infantile, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Fatima M
FM
Massenti
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Giuseppe
G
Rosafio
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Vittoria
V
Sciascia
Servizio di Ingegneria Clinica, Policlinico 'P. Giaccone', Palermo, Italy.
Flavia
F
Costa
Dipartimento Attività Sanitarie ed Osservatorio Epidemiologico, Regione Siciliana, Palermo, Italy.
Sebastiano
S
Pollina Addario
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Serena
S
Mendola
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Anna M
AM
Barile
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Vincenza
V
Maniaci
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Nadia
N
Rini
Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS), Laboratorio di Metabolismo e Nutrizione Clinica, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Gregorio
G
Caimi
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008875:Middle Aged; D009026:Mortality; D015596:Nutrition Assessment; D009752:Nutritional Status; D010351:Patient Discharge; D010362:Patients' Rooms; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
Bioimpedance; hospitalization; malnutrition; mini-nutritional assessment; mortality; phase angle