Effect of Nutritional Risk at Admission on the Length of Hospital Stay and Mortality in Gastrointestinal Cancer Patients

Abstract

This retrospective study was conducted to determine whether increased length of hospital stay (LOS) and mortality are associated with nutritional risk upon hospital admission in gastrointestinal cancer patients, using a computerized screening tool developed by a university hospital. We included adult gastrointestinal cancer patients whose hospital stays ranged from 24 hours to 90 days. The sample included 4,345 patients. The average age of the patients was 60.5 ± 11.4 years and 2,959 (68.1%) were males. The mean of LOS was 8.2 ± 8.2 days and the mortality rate was 3.4% (n = 146). The majority of the patients were at low risk (LG) (n = 3,102 [71.4%]), while 779 patients (17.9%) were at moderate risk (MG), and 464 (10.7%) were at high risk (HG). In comparing the three groups based on nutritional risk, hospital LOS was significantly longer in the HG (11.4 ± 11.4 days) than it was in the LG (7.7 ± 7.9 days) and the MG (7.9 ± 7.9 days) (p < 0.0001). Significant differences were found in the hospital mortality rate, which was the highest in the HG (13.6%) and the lowest in the LG (1.5%) (p < 0.0001). In the multiple logistic regression analysis, moderate-to-severe nutritional risk, increased age, and emergency admission were selected as significant variables for increased LOS and mortality. Further research is needed to evaluate the benefits of nutritional screening and intervention and their effect on outcomes in various disease populations.

Relationship Between Nutritional Status and the Clinical Outcomes of Patients With and Without Neoplasms According to Multiple Correspondence Analysis

“…The MCA map for neoplastic patients evidenced that the variables death and LOHS ≥7 days were associated with many indicators of nutritional risk according to the NRS, malnutrition according to the SGA, underweight according to BMI, depletion of lean and fat masses according to body composition parameters, and recent weight loss. These findings have been described by other studies using another type of analysis (1,2,22,23,24) . The present study has found that nutritional status-related variables are associated with routine clinical outcomes during hospital stay.…”

“…For many years, many studies have reported undesirable outcomes that may occur during the hospital stay of patients diagnosed with malnutrition or even at some nutritional risk (28,31) . These findings have been observed in patients with neoplasms, digestive tract diseases, and other clinical situations (22,24,31) .…”

“…Many studies have investigated the nutritional status of hospitalized patients and its relationship with the risk factors associated with clinical intercurrences during hospital stay (3,(22)(23)(24)27,28,31) . These studies have found strong associations between the nutritional status of these patients and the presence of complications, death, and a lengthy hospital stay, and many have established these associations with logistic regression analyses (24,22,28,31) . The current study differs from other studies because it used MCA to investigate the relationship between nutritional status and clinical outcomes.…”

“…Vânia Aparecida LEANDRO-MERHI 1 and José Luiz Braga de AQUINO 2 assessment (22,28,29,34) , biochemical parameters (24,29) , and anthropometry (3,22,24,29) to investigate the relationship between poor nutritional status and bad clinical outcomes, and many of these methods have been considered good predictors of bad clinical outcomes during hospital stay (24,28) . Yet, other studies have suggested the combination of subjective and objective methods (29) for nutritional status assessment.…”

“…Depletion of nutritional status has been associated with many unsatisfactory clinical outcomes in hospitalized patients and in various clinical situations (3,4,14,24,32) . For many years, many studies have reported undesirable outcomes that may occur during the hospital stay of patients diagnosed with malnutrition or even at some nutritional risk (28,31) .…”