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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.

SUBMITTER: Sharma Y

PROVIDER: S-EPMC5695574 | biostudies-literature | 2017 Nov

REPOSITORIES: biostudies-literature

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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.

Sharma Yogesh Y Miller Michelle M Kaambwa Billingsley B Shahi Rashmi R Hakendorf Paul P Horwood Chris C Thompson Campbell C

BMJ open 20171112 11

<h4>Objective</h4>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.<h4>Design, setting and participants</h4>The study prospectively recruited 297 patients ≥60 years old who were presenting to the General Medicine Department of a tertiar ...[more]

PMID: 29133331

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Project description:Background and Aims: Patients with acute decompensated (AD) cirrhosis are frequently readmitted to the hospital. An accurate predictive model for identifying high-risk patients may facilitate the development of effective interventions to reduce readmission rates. Methods: This cohort study of patients with AD cirrhosis was conducted at six tertiary hospitals in China between September 2012 and December 2016 (with 705 patients in the derivation cohort) and between January 2017 and April 2020 (with 251 patients in the temporal validation cohort). Least absolute shrinkage and selection operator Cox regression was used to identify the prognostic factors and construct a nomogram. The discriminative ability, calibration, and clinical net benefit were evaluated based on the C-index, area under the curve, calibration curve, and decision curve analysis. Kaplan-Meier curves were constructed for stratified risk groups, and log-rank tests were used to determine significant differences between the curves. Results: Among 956 patients, readmission rates were 24.58, 42.99, and 51.78%, at 30, 60, and 90 days, respectively. Bacterial infection was the main reason for index hospitalization and readmission. Independent factors in the nomogram included gastrointestinal bleeding [hazard rate (HR): 2.787; 95% confidence interval (CI): 2.221-3.499], serum sodium (HR: 0.955; 95% CI: 0.933-0.978), total bilirubin (HR: 1.004; 95% CI: 1.003-1.005), and international normalized ratio (HR: 1.398; 95% CI: 1.126-1.734). For the convenience of clinicians, we provided a web-based calculator tool (https://cqykdx1111.shinyapps.io/dynnomapp/). The nomogram exhibited good discrimination ability, both in the derivation and validation cohorts. The predicted and observed readmission probabilities were calibrated with reliable agreement. The nomogram demonstrated superior net benefits over other score models. The high-risk group (nomogram score >56.8) was significantly likely to have higher rates of readmission than the low-risk group (nomogram score ≤ 56.8; p < 0.0001). Conclusions: The nomogram is useful for assessing the probability of short-term readmission in patients with AD cirrhosis and to guide clinicians to develop individualized treatments based on risk stratification.

Project description:ObjectiveDeveloping and validating a risk assessment tool aiming to identify older adults (≥65 years) at increased risk of possibly medication-related readmission to hospital within 30 days of discharge.DesignRetrospective cohort study.SettingThe risk score was developed using data from a hospital in southern Sweden and validated using data from four hospitals in the mid-eastern part of Sweden.ParticipantsThe development cohort (n=720) was admitted to hospital during 2017, whereas the validation cohort (n=892) was admitted during 2017-2018.MeasuresThe risk assessment tool aims to predict possibly medication-related readmission to hospital within 30 days of discharge. Variables known at first admission and individually associated with possibly medication-related readmission were used in development. The included variables were assigned points, and Youden's index was used to decide a threshold score. The risk score was calculated for all individuals in both cohorts. Area under the receiver operating characteristic (ROC) curve (c-index) was used to measure the discrimination of the developed risk score. Sensitivity, specificity and positive and negative predictive values were calculated using cross-tabulation.ResultsThe developed risk assessment tool, the Hospitalisations, Own home, Medications, and Emergency admission (HOME) Score, had a c-index of 0.69 in the development cohort and 0.65 in the validation cohort. It showed sensitivity 76%, specificity 54%, positive predictive value 29% and negative predictive value 90% at the threshold score in the development cohort.ConclusionThe HOME Score can be used to identify older adults at increased risk of possibly medication-related readmission within 30 days of discharge. The tool is easy to use and includes variables available in electronic health records at admission, thus making it possible to implement risk-reducing activities during the hospital stay as well as at discharge and in transitions of care. Further studies are needed to investigate the clinical usefulness of the HOME Score as well as the benefits of implemented activities.

Dataset Information

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

Publications

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

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