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Malnutrition and its association with readmission and death within 7 days and 8–180 days postdischarge in older patients: a prospective observational study

Abstract

Objective The relationship between admission nutritional status and clinical outcomes following hospital discharge is not well established. This study investigated whether older patients’ nutritional status at admission predicts unplanned readmission or death in the very early or late periods following hospital discharge.

Design, setting and participants The study prospectively recruited 297 patients ≥60 years old who were presenting to the General Medicine Department of a tertiary care hospital in Australia. Nutritional status was assessed at admission by using the Patient-Generated Subjective Global Assessment (PG-SGA) tool, and patients were classified as either nourished (PG-SGA class A) or malnourished (PG-SGA classes B and C). A multivariate logistic regression model was used to adjust for other covariates known to influence clinical outcomes and to determine whether malnutrition is a predictor for early (0–7 days) or late (8–180 days) readmission or death following discharge.

Outcome measures The impact of nutritional status was measured on a combined endpoint of any readmission or death within 0–7 days and between 8 and 180 days following hospital discharge.

Results Within 7 days following discharge, 29 (10.5%) patients had an unplanned readmission or death whereas an additional 124 (50.0%) patients reached this combined endpoint within 8–180 days postdischarge. Malnutrition was associated with a significantly higher risk of combined endpoint of readmissions or death both within 7 days (OR 4.57, 95% CI 1.69 to 12.37, P<0.001) and within 8–180 days (OR 1.98, 95% CI 1.19 to 3.28, P=0.007) following discharge and this risk remained significant even after adjustment for other covariates.

Conclusions Malnutrition in older patients at the time of hospital admission is a significant predictor of readmission or death both in the very early and in the late periods following hospital discharge. Nutritional state should be included in future risk prediction models.

Trial registration number ACTRN No. 12614000833662; Post-results.

  • geriatric medicine
  • quality in health care
  • general medicine (see internal medicine)

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors YS, CT and MM designed the study and YS, CT, BK and MM carried out the analysis and interpretation. YS, PH and CH provided statistical input. YS and RS undertook recruitment. YS and CT wrote the manuscript, which was edited by BK, RS and MM. All authors approved final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethical approval was obtained from Southern Adelaide Human Research Committee (SAC HREC; approval number 273.14-HREC/14/SAC/282) on 21 July 2014.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data that support the findings of this study are available from the corresponding author on reasonable request.

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