Ten-year all-cause mortality in hospitalized non-surgical patients based on nutritional status screening

Abstract

Objective: Malnutrition is common in patients admitted to hospital due to acute illness and contributes to negative patient outcomes. In Slovakia there is a lack of relevant data on malnutrition in hospitalized patients, particularly based on chronic co-morbidity and survival. The aim of the present study was to explore the prevalence of malnutrition in hospitalized chronic patients, its relationship to co-morbidity and its impact on 10-year survival.

Design: Retrospective cohort study.

Setting: Nutritional status was estimated by Subjective Global Assessment (SGA), BMI and serum albumin level. Survival was assessed from the National Insurance Registry over a 10-year period. The association between nutritional status measured by SGA and 10-year survival controlling for age, gender, BMI and serum albumin was analysed using Cox regression.

Subjects: Data were taken from the medical records of 202 consecutively admitted chronic patients. Results Median age was 63·5 years; 55·4 % were males; median BMI was 25·9 kg/m2; median serum albumin level was 39·0 g/l. Based on SGA evaluation, 38·1 % did not have sufficient nutritional status (SGA classification B and C). Malnutrition was more common in patients who were older (P=0·023), with lower BMI (P<0·001), who had gastrointestinal (P=0·049) and oncologic co-morbidity (P=0·021) and lower albumin level (P=0·049). In-hospital mortality was 3 %, but during the following 10 years 52 % died. Cox regression analysis controlling for age, gender, BMI and serum albumin showed that SGA was an independent predictor of death (hazard ratio=1·55; 95 % CI 1·04, 2·32; P=0·031).

Conclusions: SGA is a simple screening tool that can be routinely used in hospitalized Slovak medical patients to predict the risk of death. Improving patient nutrition could thus reduce mortality.

Keywords: All-cause mortality; Co-morbidity; Nutritional status; Subjective Global Assessment (SGA); Survival.

Fig. 1

Kaplan–Meier curves showing the association between nutritional status as evaluated by SGA (——, normal nutrition, SGA classification A; – – – – –, malnutrition, SGA classification B and C) and 10-year survival among hospitalized non-surgical patients (n 202; median age 63·5 years) admitted to Nitra Teaching Hospital, Slovak Republic, April–June 2003 (SGA, Subjective Global Assessment)