1.
[Comparison of the CONUT method with SGA and NSA for the prediction of complications, hospital stay, readmissions, and mortality].
García-Vazquez, N, Palma Milla, S, López Plaza, B, Valero-Pérez, M, Morato-Martínez, M, Gómez Candela, C
Nutricion hospitalaria. 2020;(4):799-806
Abstract
Introduction: disease-related malnutrition (DRM) is a specific type of malnutrition caused by the inflammatory response to the underlying disease. Its prevalence worldwide varies from 30 % to 50 %, being similar in Spanish hospitals. DRE is not commonly recognized but is usually misdiagnosed and generally not treated. It is associated with an increased risk of morbidity, mortality, and costs. Nutritional societies recommend that screening be performed within the first 24 to 48 hours after admission for the early detection of malnutrition. No screening tool is universally accepted. Objectives: to evaluate the predictive validity (hospital stay, complications, readmissions and mortality) of the CONUT method as compared to SGA and NSA. Material and method: a retrospective study included in a prospective observational study of 365 hospitalized patients from July to December 2012. Results: the most frequent admission services were Internal Medicine and Oncology (30.7 % and 29.3 %). Moderate and severe risk of malnutrition: CONUT, 42.2 % and 12.1 %, SGA 25.8 % and 10.1 %, and NSA 13.7 % and 14.5 %. Malnutrition evaluated using the CONUT method was significantly related to complications (p = 0.036), readmissions (p = 0.041) and mortality (p = 0.007). The ROC curves for mortality, for all the methods evaluated, showed that CONUT is the best tool. Conclusions: CONUT is an automatic detection tool that can be used as a first step in the diagnosis risk of malnutrition. CONUT offers the advantage of being a prognostic factor for complications, readmission, and mortality.
2.
Prediction of prognosis in chronic obstructive pulmonary disease patients with respiratory failure: A comparison of three nutritional assessment methods.
Chen, R, Xing, L, You, C, Ou, X
European journal of internal medicine. 2018;:70-75
Abstract
OBJECTIVES Due to their increased energy expenditure, chronic obstructive pulmonary disease (COPD) patients with respiratory failure are susceptible to malnutrition. This study aimed to compare the predictive values of the following three widely used nutritional assessment methods for the clinical prognosis of COPD patients with respiratory failure: body mass index (BMI), Nutritional Risk Screening 2002 (NRS 2002), and serum albumin (ALB) level. METHODS COPD patients with respiratory failure treated in our center from June 2013 to June 2016 were retrospectively included. Patient BMI, NRS 2002 and ALB values were measured to assess their nutritional status. A multivariable analysis was conducted, and receiver operating characteristic (ROC) curves were generated to explore the predictive factors for clinical prognoses. RESULTS A total of 438 qualified patients were enrolled in our study. Multivariable analysis revealed that the BMI and ALB values independently predicted in-hospital mortality, the BMI and NRS 2002 predicted 1-year mortality, and all three methods (BMI, NRS 2002, and ALB) predicted 30-day readmission after discharge (P < 0.05). Regarding the results of the AUROC analysis, the optimal cutoff values that maximized the ability to predict the prognosis were an ALB level of 30.5 g/L for in-hospital mortality, an NRS 2002 score of 3 points for 1-year mortality, and an ALB level of 30.1 g/L for readmission within 30 days following discharge. CONCLUSIONS For COPD patients with respiratory failure, ALB level was superior for predicting in-hospital mortality and 30-day readmission after discharge, and NRS 2002 was superior for long-term prognosis of 1-year mortality.
3.
Timing and Causes of Readmission After Acute Heart Failure Hospitalization-Insights From the Heart Failure Network Trials.
Vader, JM, LaRue, SJ, Stevens, SR, Mentz, RJ, DeVore, AD, Lala, A, Groarke, JD, AbouEzzeddine, OF, Dunlay, SM, Grodin, JL, et al
Journal of cardiac failure. 2016;(11):875-883
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Abstract
BACKGROUND Readmission or death after heart failure (HF) hospitalization is a consequential and closely scrutinized outcome, but risk factors may vary by population. We characterized the risk factors for post-discharge readmission/death in subjects treated for acute heart failure (AHF). METHODS AND RESULTS A post hoc analysis was performed on data from 744 subjects enrolled in 3 AHF trials conducted within the Heart Failure Network (HFN): Diuretic Optimization Strategies Evaluation in Acute Heart Failure (DOSE-AHF), Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF), and Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF). All-cause readmission/death occurred in 26% and 38% of subjects within 30 and 60 days of discharge, respectively. Non-HF cardiovascular causes of readmission were more common in the ≤30-day timeframe than in the 31-60-day timeframe (23% vs 10%, P = .016). In a Cox proportional hazards model adjusting a priori for left ventricular ejection fraction <50% and trial, the risk factors for all-cause readmission/death included: elevated baseline blood urea nitrogen, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) non-use, lower baseline sodium, non-white race, elevated baseline bicarbonate, lower systolic blood pressure at discharge or day 7, depression, increased length of stay, and male sex. CONCLUSIONS In an AHF population with prominent congestion and prevalent renal dysfunction, early readmissions were more likely to be due to non-HF cardiovascular causes compared with later readmissions. The association between use of ACEI/ARB and lower all-cause readmission/death in Cox proportional hazards model suggests a role for these drugs to improve post-discharge outcomes in AHF.