Nutritional risk as predictor for healthcare-associated infection among hospitalized elderly patients in the acute care setting

• Published in: The Journal of hospital infection 2012-02, Vol.80 (2), p.168-172
• Main Authors: Gamaletsou, M.N, Poulia, K.-A, Karageorgou, D, Yannakoulia, M, Ziakas, P.D, Zampelas, A, Sipsas, N.V
• Format: Article
• Language: English
• Subjects: Acute Disease - therapy; Aged; Aged, 80 and over; Biological and medical sciences; Critical Care - methods; Cross Infection - epidemiology; Elderly; Female; General aspects; Healthcare-associated infection; Human infectious diseases. Experimental studies and models; Humans; Infectious Disease; Infectious diseases; Male; Malnutrition; Medical sciences; Metabolic diseases; Nutrition Assessment; Nutritional Status; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Risk Assessment
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2011.08.020

Summary Background Poor nutritional status is associated with high rates of healthcare-associated infections (HCAIs) among hospitalized elderly patients. Early recognition of patients at risk for HCAIs is important. The Geriatric Nutritional Risk Index (GNRI) is a screening tool able to predict nutrition-related complications. Aim To examine the use of GNRI as a predictor of HCAIs in the acute care setting. Methods A total of 248 consecutive patients aged >65 years, admitted as emergencies to the medical ward of an acute care hospital, were enrolled. On admission, clinical and laboratory assessment, anthropometric measurements, performance status, and GNRI score estimation were performed. HCAIs were recorded during admission. Findings On admission, 53.8% of the patients were not at risk, 37.2% at low or medium risk and 8.9% at high risk for nutrition-related complications, as stratified by using the GNRI. During hospitalization 23.7% of the patients developed HCAIs. Patients with HCAIs had higher mortality ( P < 0.001) and longer hospital stay ( P < 0.001). In multivariate analysis, a performance status >1 [hazard ratio (HR): 2.08; 95% confidence interval (CI): 1.07–4.02; P  = 0.03] and diabetes (HR: 2.57; 95% CI: 1.37–4.84; P = 0.003) were associated with increased risk for HCAIs, whereas GNRI score (per unit increase) had a protective effect (HR: 0.97; 95% CI: 0.95–0.99; P = 0.01). Well-nourished patients (GNRI >98) were significantly more likely to remain free from HCAIs during hospitalization ( P  = 0.003). Conclusion GNRI can accurately stratify hospitalized elderly patients according to risk for developing HCAIs.