亜急性期高齢脳卒中の低栄養と予後

亜急性期の高齢脳卒中患者では、栄養状態が悪いと入院期間が長く、18カ月後の機能予後が悪く、死亡率が高いという報告です。MNAで30％が低栄養、53％が低栄養のおそれありです。回復期のリハ栄養的に重要な論文だと思います。

Charlton K, Nichols C, Bowden S, Milosavljevic M, Lambert K, Barone L, Mason M, Batterham M.　Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up.　Eur J Clin Nutr. 2012 Nov;66(11):1224-8.

Abstract

BACKGROUND/OBJECTIVES:

Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up.

SUBJECTS/METHODS:

A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n = 476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates.

RESULTS:

At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P<0 .001="" 0.001="" 1.07-10.87="" 16.9="" 3.41="" 33.1="" 4.9="" a="" and="" at-risk="" care="" confidence="" death="" discharge="" for="" group.="" group="" hazard="" higher="" in="" interval:="" is="" level="" malnourished="" of="" p="" patients="" rate="" residential="" respectively="" the="" times="" to="" was="" well-nourished="">

CONCLUSION:

Malnutrition in elderly subacute patients predicts adverse clinical outcomes and identifies a need to target this population for nutritional intervention following hospital discharge.