Malnutrition, Critical Illness Survivors, and Postdischarge Outcomes: A Cohort Study.

We hypothesized that preexisting malnutrition in patients who survived critical care would be associated with adverse outcomes following hospital discharge. We performed an observational cohort study in 1 academic medical center in Boston. We studied 23,575 patients, aged ≥18 years, who received critical care between 2004 and 2011 and survived hospitalization. The exposure of interest was malnutrition determined at intensive care unit (ICU) admission by a registered dietitian using clinical judgment and on data related to unintentional weight loss, inadequate nutrient intake, and wasting of muscle mass and/or subcutaneous fat. The primary outcome was 90-day postdischarge mortality. Secondary outcome was unplanned 30-day hospital readmission. Adjusted odds ratios were estimated by logistic regression models adjusted for age, race, sex, Deyo-Charlson Index, surgical ICU, sepsis, and acute organ failure. In the cohort, the absolute risk of 90-day postdischarge mortality was 5.9%, 11.7%, 15.8%, and 21.9% in patients without malnutrition, those at risk of malnutrition, nonspecific malnutrition, and protein-energy malnutrition, respectively. The odds of 90-day postdischarge mortality in patients at risk of malnutrition, nonspecific malnutrition, and protein-energy malnutrition fully adjusted were 1.77 (95% confidence interval [CI], 1.23-2.54), 2.51 (95% CI, 1.36-4.62), and 3.72 (95% CI, 2.16-6.39), respectively, relative to patients without malnutrition. Furthermore, the presence of malnutrition is a significant predictor of the odds of unplanned 30-day hospital readmission. In patients treated with critical care who survive hospitalization, preexisting malnutrition is a robust predictor of subsequent mortality and unplanned hospital readmission.

Mogensen KM ，Horkan CM ，Purtle SW ，Moromizato T ，Rawn JD ，Robinson MK ，Christopher KB ... -  《-》

The association of acute kidney injury in the critically ill and postdischarge outcomes: a cohort study*.

Horkan CM ，Purtle SW ，Mendu ML ，Moromizato T ，Gibbons FK ，Christopher KB ... -  《-》

Nucleated red blood cells, critical illness survivors and postdischarge outcomes: a cohort study.

Purtle SW ，Horkan CM ，Moromizato T ，Gibbons FK ，Christopher KB ... -  《CRITICAL CARE》

The association of red cell distribution width at hospital discharge and out-of-hospital mortality following critical illness*.

Purtle SW ，Moromizato T ，McKane CK ，Gibbons FK ，Christopher KB ... -  《-》

The relationship among obesity, nutritional status, and mortality in the critically ill.

Robinson MK ，Mogensen KM ，Casey JD ，McKane CK ，Moromizato T ，Rawn JD ，Christopher KB ... -  《-》