Dataset Information

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

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?Conclusions and relevanceThese 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.

SUBMITTER: Kaegi-Braun N

PROVIDER: S-EPMC7818145 | biostudies-literature | 2021 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Kaegi-Braun Nina N Mueller Marlena M Schuetz Philipp P Mueller Beat B Kutz Alexander A

JAMA network open 20210104 1

<h4>Importance</h4>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.<h4>Objective</h4>To investigate whether there is an association of nutritional support with in-hospital mortality in routine clinical practice.<h4>Design, setting, and participants</h4>This cohort study was conducted from April 2013 to December 2018 among a population of ...[more]

PMID: 33471118

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Project description:BackgroundMalnutrition is present in 30% of hospitalized patients and has adverse outcomes for the patient and the healthcare system. The current practice for nutritional care is associated with many barriers. The MyFood decision support system was developed to prevent and treat malnutrition.MethodsThis paper reports on a process evaluation that was completed within an effectiveness trial. MyFood is a digital tool with an interface consisting of an app and a website. MyFood includes functions to record and evaluate dietary intake. It also provides reports to nurses, including tailored recommendations for nutritional treatment. We used an effectiveness-implementation hybrid design in a randomized controlled trial. The RE-AIM (Reach, Efficiency, Adoption, Implementation, Maintenance) framework was used to perform a process evaluation alongside the randomized controlled trial, using a combination of quantitative and qualitative methods. An implementation plan, including implementation strategies, was developed to plan and guide the study.ResultsReach: In total, 88% of eligible patients consented to participate (n = 100). Adoption: Approximately 75% of the nurses signed up to use MyFood and 50% used the reports.ImplementationMyFood empowered the patients in their nutritional situation and acted as a motivation to eat to reach their nutritional target. The compliance of using MyFood was higher among the patients than the nurses. A barrier for use of MyFood among the nurses was different digital systems which were not integrated and the log-in procedure to the MyFood website. Despite limited use by some nurses, the majority of the nurses claimed that MyFood was useful, better than the current practice, and should be implemented in the healthcare system.ConclusionsThis study used a process evaluation to interpret the results of a randomized controlled trial more in-depth. The patients were highly compliant, however, the compliance was lower among the nurses. MyFood empowered the patients in their nutritional situation, the usability was considered as high, and the experiences and attitudes towards MyFood were primarily positive. Focus on strategies to improve the nurses' compliance may in the future improve the MyFood system's potential.Trial registrationThe trial was registered in ClinicalTrials.gov 26/01/2018 ( NCT03412695 ).

Project description:Background/aim:Malnutrition is an important and commonly seen prognostic factor in patients with cirrhosis. The diagnosis of malnutrition in cirrhosis patients may be challenging, and an easily measured and widely usable marker is lacking. Prealbumin, however, is an easily measured marker. In the current study we measured prealbumin levels in cirrhotic patients with no clinically apparent malnutrition and used it as a malnutrition marker. Another aim of this study was to evaluate the effect of nutritional support on patient with low prealbumin levels. Materials and methods:Fifty-two patients with Child A and Child B cirrhosis were selected for the study. Prealbumin levels were studied, and Child and MELD scores were calculated. Patients with prealbumin levels ?180 mg/L were considered to have malnutrition, and two different types of nutritional products were given to these patients. The patients given nutritional support were investigated a month later, and parameters were compared. Results:According to the prealbumin threshold of 180 mg/L, malnutrition frequencies were 59.3% for Child A and 95% for Child B cirrhosis. After the provision of nutritional support statistically significant improvements in albumin and INR levels were detected. In addition, the MELD score decreased; however, it was not statistically significant (P: 0.088). A statistically significant decrease in the MELD score was only obtained in patients with Child B cirrhosis (P: 0.033). When the oral replacement therapies were investigated separately, a statistically significant decrease in MELD scores was detected with product 1 (P: 0.043). Conclusion:Prealbumin can be used as an easily measured parameter for earlier detection of malnutrition in patients with cirrhosis and without clinically apparent malnutrition. Oral nutritional support, especially with products containing relatively high carbohydrate levels and low protein, may have a favorable effect on MELD scores.

Dataset Information

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

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Publications

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

Similar Datasets

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