Journal of the American College of Nutrition, Vol 14, Issue 1 29-36, Copyright © 1995 by American College of Nutrition

CLINICAL TRIAL

The risk of life-threatening complications in a select population of geriatric patients: the impact of nutritional status

D. H. Sullivan and R. C. Walls
Geriatric Research Education and Clinical Center, John L. McClellan Memorial Veterans Hospital, Little Rock, AR 72205, USA.

OBJECTIVE: The primary objective of this study was to assess the interrelationship between protein-energy nutritional status, disease severity, and life-threatening complications in a population of elderly rehabilitation patients. METHODS: Three-hundred and fifty randomly selected admissions to Geriatric Rehabilitation Unit of a Veterans Administration hospital were prospectively studied. The average age of the study subjects was 76 years, nearly all (99%) were male, and 75% were white. At admission, each patient completed a comprehensive medical, functional, neuropsychological, socioeconomic, and nutritional assessment. While remaining in the hospital, each subject was monitored on a daily basis for the development of complications. RESULTS: Of the 96 variables evaluated, the best predictors of developing at least one life-threatening complication were serum albumin, body mass index, the presence of renal disease (i.e. blood urea nitrogen > 30 mg/L), the Katz Index of Activities of Daily Living score, and the amount of weight loss in the year prior to admission. When all of these variables were included in the logistic regression analysis, the final model was highly significant by the -2Log Likelihood Chi-square goodness-of-fit criterion (Chi-square of 64.1 with 5 d.f., p < 0.0001) with a sensitivity of 77%, a specificity of 77% and an overall predictive accuracy of 77%. When the predictive accuracy of the logistic model was tested using a second sample of 110 patients, the model differentiated those who developed a life-threatening complication from those who had not with a sensitivity of 88%, a specificity of 61%, and an overall predictive accuracy of 65%. As indicated by the Chi-square test, these results were significant (p < 0.0001). CONCLUSIONS: Protein-energy undernutrition appears to be a strong independent risk factor for life-threatening morbidity during hospitalization.

This article has been cited by other articles:

				G. L. Jensen Inflammation as the Key Interface of the Medical and Nutrition Universes: A Provocative Examination of the Future of Clinical Nutrition and Medicine JPEN J Parenter Enteral Nutr, September 1, 2006; 30(5): 453 - 463. [Abstract] [Full Text] [PDF]

				H. Castel, D. Shahar, and I. Harman-Boehm Gender differences in factors associated with nutritional status of older medical patients. J. Am. Coll. Nutr., April 1, 2006; 25(2): 128 - 134. [Abstract] [Full Text] [PDF]

				N. Kagansky, Y. Berner, N. Koren-Morag, L. Perelman, H. Knobler, and S. Levy Poor nutritional habits are predictors of poor outcome in very old hospitalized patients Am. J. Clinical Nutrition, October 1, 2005; 82(4): 784 - 791. [Abstract] [Full Text] [PDF]

				D. H. Sullivan, C. L. Nelson, V. S. Klimberg, and M. M. Bopp Nightly Enteral Nutrition Support of Elderly Hip Fracture Patients: A Pilot Study J. Am. Coll. Nutr., December 1, 2004; 23(6): 683 - 691. [Abstract] [Full Text] [PDF]

				H. Sungurtekin, U. Sungurtekin, C. Balci, M. Zencir, and E. Erdem The Influence of Nutritional Status on Complications after Major Intraabdominal Surgery J. Am. Coll. Nutr., June 1, 2004; 23(3): 227 - 232. [Abstract] [Full Text] [PDF]

				C. Paquet, D. St-Arnaud-McKenzie, M.-J. Kergoat, G. Ferland, and L. Dube Direct and Indirect Effects of Everyday Emotions on Food Intake of Elderly Patients in Institutions J. Gerontol. A Biol. Sci. Med. Sci., February 1, 2003; 58(2): M153 - 158. [Abstract] [Full Text] [PDF]

				D. R Thomas, C. D Zdrowski, M.-M. Wilson, K. C Conright, C. Lewis, S. Tariq, and J. E Morley Malnutrition in subacute care Am. J. Clinical Nutrition, February 1, 2002; 75(2): 308 - 313. [Abstract] [Full Text] [PDF]

				D. H. Sullivan, S. Sun, and R. C. Walls Protein-Energy Undernutrition Among Elderly Hospitalized Patients: A Prospective Study JAMA, June 2, 1999; 281(21): 2013 - 2019. [Abstract] [Full Text] [PDF]

				J. V. White Invited Review: The Nutrition Screening Initiative: A 5-Year Perspective Nutr Clin Pract, June 1, 1996; 11(3): 89 - 93. [Abstract] [PDF]