Utilizing multiple methods to classify malnutrition among elderly patients admitted to the medical and surgical intensive care units (ICU)

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2013-10, Vol.32 (5), p.752-757
• Main Authors: Sheean, Patricia M, Peterson, Sarah J, Chen, Yimin, Liu, Dishan, Lateef, Omar, Braunschweig, Carol A
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aging; APACHE; Biological and medical sciences; body composition; Chicago; Chicago - epidemiology; Cohort Studies; complications; death; diagnosis; Elderly; epidemiology; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; General Surgery; Geriatric Assessment; Hospitals, Urban; Humans; inflammation; Intensive care unit; Intensive Care Units; Internal Medicine; Length of Stay; Male; Malnutrition; Malnutrition - complications; Malnutrition - diagnosis; Malnutrition - epidemiology; Medical sciences; Metabolic diseases; Mini nutrition assessment; Nutrition Assessment; Nutrition risk score 2002; Nutritional status; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); patients; Prevalence; Prospective Studies; regression analysis; Risk; Sensitivity and Specificity; Subjective global assessment; Vertebrates: anatomy and physiology, studies on body, several organs or systems
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2012.12.012

Summary Background & aims The nutritional status of elderly patients requiring ICU admission is largely unknown. This study evaluated the prevalence of malnutrition in elderly patients (>65 years) admitted to the surgical and medical ICUs, agreement between assessment techniques and associations between malnutrition and adverse outcomes. Methods For this prospective cohort, nutritional status was classified concurrently using the Mini Nutrition Assessment (MNA), Subjective Global Assessment (SGA), Nutrition Risk Score 2002 (NRS 2002) and MNA-short form (MNA-SF). Demographic and relevant medical information were collected from the medical record prior to the nutrition interview and/or following hospital discharge. Descriptive statistics, inter-rater agreement and regression analyses were conducted. Results The average patient was 74.2 (±6.8) years of age with a mean APACHE II score of 11.9 (±3.6). Malnutrition was prevalent in 23–34% of patients ( n  = 260) with excellent agreement between raters. Compared to MNA, NRS 2002 had the highest sensitivity, while SGA and MNA-SF had higher specificity. Malnutrition at ICU admission was associated with longer hospital LOS, a lower propensity for being discharged home and a greater need for hospice care or death at discharge (all p values