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. 2021 Jan 4;4(1):e2033433.
doi: 10.1001/jamanetworkopen.2020.33433.

Evaluation of Nutritional Support and In-Hospital Mortality in Patients With Malnutrition

Nina Kaegi-Braun  1   2 , Marlena Mueller  1   2 , Philipp Schuetz  1   2   3 , Beat Mueller  1   2   3 , Alexander Kutz  1   2
Affiliations

Evaluation of Nutritional Support and In-Hospital Mortality in Patients With Malnutrition

Nina Kaegi-Braun et al. JAMA Netw Open. .

Abstract

Importance: Malnutrition affects a considerable proportion of patients in the hospital and is associated with adverse clinical outcomes. Recent trials found a survival benefit among patients receiving nutritional support.

Objective: To investigate whether there is an association of nutritional support with in-hospital mortality in routine clinical practice.

Design, setting, and participants: This cohort study was conducted from April 2013 to December 2018 among a population of patients from Swiss administrative claims data. From 114 264 hospitalizations of medical patients with malnutrition, 34 967 patients (30.6%) receiving nutritional support were 1:1 propensity score matched to patients with malnutrition in the hospital who were not receiving nutritional support. Patients in intensive care units were excluded. Data were analyzed from February 2020 to November 2020.

Exposures: Receiving nutritional support, including dietary advice, oral nutritional supplementation, or enteral and parenteral nutrition.

Main outcomes and measures: The primary outcome was all-cause in-hospital mortality. Secondary outcomes were 30-day all-cause hospital readmission and discharge to a postacute care facility. Poisson and logistic regressions were used to estimate incidence rate ratios (IRRs) and odds ratios (ORs) of outcomes.

Results: After matching, the study identified 69 934 hospitalizations of patients coded as having malnutrition in the cohort (mean [SD] age, 73.8 [14.5] years; 36 776 [52.6%] women). Patients receiving nutritional support, compared with those not receiving nutritional support, had a lower in-hospital mortality rate (2525 of 34 967 patients died [7.2%] vs 3072 of 34 967 patients died [8.8%]; IRR, 0.79 [95% CI, 0.75-0.84]; P < .001) and a reduced 30-day readmission rate (IRR, 0.95 [95% CI, 0.91-0.98]; P = .002). In addition, patients receiving nutritional support were less frequently discharged to a postacute care facility (13 691 patients [42.2%] vs 14 324 patients [44.9%]; OR, 0.89 [95% CI, 0.86-0.91]; P < .001).

Conclusions and relevance: These findings suggest that nutritional support was associated with reduced mortality among patients in the medical ward with malnutrition. The results support data found by randomized clinical trials and may help to inform patients, clinicians, and authorities regarding the usefulness of nutritional support in clinical practice.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Schuetz reported receiving unrestricted grant money unrelated to this project from Nestlé Health Science and Abbott Nutrition paid to his institution. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
ICU indicates intensive care unit; ICD-10, International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; CHOP, Swiss Classification of Operations code.
Figure 2.
Figure 2.. Kaplan-Meier Curve for Propensity Score–Matched Rate of All-Cause In-Hospital Mortality
HR indicates hazard ratio. HR was adjusted by hospital site.
Figure 3.
Figure 3.. Propensity Score–Matched Incidence Rate Ratios (IRRs) for In-Hospital Mortality Stratified by Patient Characteristic
Stratified by age, sex, main diagnoses, comorbidities, degree of malnutrition, hospital frailty risk score, and length of hospital stay.
See this image and copyright information in PMC

Comment in

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