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Nutritional Status and Mortality in the Critically Ill.
Crit Care Med. 2015 Dec; 43(12):2605-15.CC

Abstract

OBJECTIVES

The association between nutritional status and mortality in critically ill patients is unclear based on the current literature. To clarify this relation, we analyzed the association between nutrition and mortality in a large population of critically ill patients and hypothesized that mortality would be impacted by nutritional status.

DESIGN

Retrospective observational study.

SETTING

Single academic medical center.

PATIENTS

Six thousand five hundred eighteen adults treated in medical and surgical ICUs between 2004 and 2011.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

All cohort patients received a formal, in-person, standardized evaluation by a registered dietitian. The exposure of interest, malnutrition, was categorized as nonspecific malnutrition, protein-energy malnutrition, or well nourished and determined by data related to anthropometric measurements, biochemical indicators, clinical signs of malnutrition, malnutrition risk factors, and metabolic stress. The primary outcome was all-cause 30-day mortality determined by the Social Security Death Master File. Associations between nutrition groups and mortality were estimated by bivariable and multivariable logistic regression models. Adjusted odds ratios were estimated with inclusion of covariate terms thought to plausibly interact with both nutrition status and mortality. We used propensity score matching on baseline characteristics to reduce residual confounding of the nutrition status category assignment. In the cohort, nonspecific malnutrition was present in 56%, protein-energy malnutrition was present in 12%, and 32% were well nourished. The 30-day and 90-day mortality rates for the cohort were 19.1% and 26.6%, respectively. Nutritional status is a significant predictor of 30-day mortality following adjustment for age, gender, race, medical versus surgical patient type, Deyo-Charlson index, acute organ failure, vasopressor use, and sepsis: nonspecific malnutrition 30-day mortality odds ratio, 1.17 (95% CI, 1.01-1.37); protein-energy malnutrition 30-day mortality odds ratio, 2.10 (95% CI, 1.70-2.59), all relative to patients without malnutrition. In the matched cohort, the adjusted odds of 30-day mortality in the group of propensity score-matched patients with protein-energy malnutrition was two-fold greater than that of patients without malnutrition.

CONCLUSION

In a large population of critically ill adults, an association exists between nutrition status and mortality.

Authors+Show Affiliations

1Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts. 2Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 3Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 4Harvard Medical School, Boston, Massachusetts. 5Department of Medicine, Okinawa Hokubu Prefectural Hospital, Okinawa, Japan. 6Department of Medicine, The Nathan E. Hellman Memorial Laboratory, Renal Division, Brigham and Women's Hospital.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26427592

Citation

Mogensen, Kris M., et al. "Nutritional Status and Mortality in the Critically Ill." Critical Care Medicine, vol. 43, no. 12, 2015, pp. 2605-15.
Mogensen KM, Robinson MK, Casey JD, et al. Nutritional Status and Mortality in the Critically Ill. Crit Care Med. 2015;43(12):2605-15.
Mogensen, K. M., Robinson, M. K., Casey, J. D., Gunasekera, N. S., Moromizato, T., Rawn, J. D., & Christopher, K. B. (2015). Nutritional Status and Mortality in the Critically Ill. Critical Care Medicine, 43(12), 2605-15. https://doi.org/10.1097/CCM.0000000000001306
Mogensen KM, et al. Nutritional Status and Mortality in the Critically Ill. Crit Care Med. 2015;43(12):2605-15. PubMed PMID: 26427592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutritional Status and Mortality in the Critically Ill. AU - Mogensen,Kris M, AU - Robinson,Malcolm K, AU - Casey,Jonathan D, AU - Gunasekera,Nicole S, AU - Moromizato,Takuhiro, AU - Rawn,James D, AU - Christopher,Kenneth B, PY - 2015/10/3/entrez PY - 2015/10/3/pubmed PY - 2016/3/5/medline SP - 2605 EP - 15 JF - Critical care medicine JO - Crit Care Med VL - 43 IS - 12 N2 - OBJECTIVES: The association between nutritional status and mortality in critically ill patients is unclear based on the current literature. To clarify this relation, we analyzed the association between nutrition and mortality in a large population of critically ill patients and hypothesized that mortality would be impacted by nutritional status. DESIGN: Retrospective observational study. SETTING: Single academic medical center. PATIENTS: Six thousand five hundred eighteen adults treated in medical and surgical ICUs between 2004 and 2011. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All cohort patients received a formal, in-person, standardized evaluation by a registered dietitian. The exposure of interest, malnutrition, was categorized as nonspecific malnutrition, protein-energy malnutrition, or well nourished and determined by data related to anthropometric measurements, biochemical indicators, clinical signs of malnutrition, malnutrition risk factors, and metabolic stress. The primary outcome was all-cause 30-day mortality determined by the Social Security Death Master File. Associations between nutrition groups and mortality were estimated by bivariable and multivariable logistic regression models. Adjusted odds ratios were estimated with inclusion of covariate terms thought to plausibly interact with both nutrition status and mortality. We used propensity score matching on baseline characteristics to reduce residual confounding of the nutrition status category assignment. In the cohort, nonspecific malnutrition was present in 56%, protein-energy malnutrition was present in 12%, and 32% were well nourished. The 30-day and 90-day mortality rates for the cohort were 19.1% and 26.6%, respectively. Nutritional status is a significant predictor of 30-day mortality following adjustment for age, gender, race, medical versus surgical patient type, Deyo-Charlson index, acute organ failure, vasopressor use, and sepsis: nonspecific malnutrition 30-day mortality odds ratio, 1.17 (95% CI, 1.01-1.37); protein-energy malnutrition 30-day mortality odds ratio, 2.10 (95% CI, 1.70-2.59), all relative to patients without malnutrition. In the matched cohort, the adjusted odds of 30-day mortality in the group of propensity score-matched patients with protein-energy malnutrition was two-fold greater than that of patients without malnutrition. CONCLUSION: In a large population of critically ill adults, an association exists between nutrition status and mortality. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/26427592/Nutritional_Status_and_Mortality_in_the_Critically_Ill_ L2 - https://dx.doi.org/10.1097/CCM.0000000000001306 DB - PRIME DP - Unbound Medicine ER -