Prognostic significance of malnutrition for long-term mortality in community-acquired pneumonia: a propensity score matched analysis

Abstract

Background/Aims The impact of malnutrition on the outcome of hospitalized adults with community-acquired pneumonia (CAP) has not been fully investigated. This study evaluated the prevalence and prognostic significance of malnutrition in a Korean population with CAP. Methods In total, 198 patients with CAP from November 2014 to September 2015 were analyzed retrospectively. We assessed the prevalence of malnutrition and the risk factors for 2-year mortality. Furthermore, we divided the patients into two groups: elderly (age ≥ 65 years, n = 131) and non-elderly (age < 65 years, n = 67). Subgroup analyses were performed in the elderly group through propensity score matching. Results The prevalence of malnutrition was 39.4%, and the proportion of patients with malnutrition was significantly higher (53.4% vs. 11.9%, p < 0.001) in the elderly group than in the non-elderly group. In-hospital mortality, 1-year mortality, and 2-year mortality rates were 4.5%, 19.2%, and 26.8%, respectively. Multivariate Cox regression analyses revealed that malnutrition (odds ratio [OR], 2.52; 95% confidence interval [CI], 1.39 to 4.60; p = 0.002) and the Charlson comorbidity index score (OR, 1.30; 95% CI, 1.17 to 1.45; p < 0.001) were associated with 2-year mortality. Conclusions Malnutrition was common and associated with a poor long-term outcome in patients with CAP, particularly the elderly. A routine nutritional assessment at admission is mandatory as a first step for appropriate nutritional therapy.

Impact of frailty on 30-day and 1-year mortality in hospitalised elderly patients with community-acquired pneumonia: a prospective observational study

“…Poor nutritional status, including hypoalbuminemia, hypoproteinemia, malnourishment and a low nutritional score, is a strong predictor of mortality in CAP patients. 33 34 However, in our cohort, there was no significant association between nutritional status and 30-day or 1-year mortality in the multivariate analysis (adjusted HR, 1.11; 95% CI, 0.90 to 1.35; adjusted HR, 0.94; 95% CI, 0.81 to 1.10, respectively). Some studies have shown that the definition, diagnosis and treatment of frailty and malnutrition overlap.…”

Impact of Protein Energy Malnutrition on Outcomes of Adults With Viral Pneumonia: A Nationwide Retrospective Analysis

“…Only 5% of patients with viral CAP had PEM, which was significantly lower than previously reported. One study showed that the prevalence of malnutrition is as high as 40% among hospitalized patients [ 21 ], rising to 53.4% of elderly patients [ 12 ]. The low prevalence of PEM in the study population may be explained by under-diagnosis; the lack of an initial nutritional assessment in many hospitalized patients may be the driving factor.…”

“…Some studies found that PEM is associated with increased morbidity and mortality, longer length of hospital stay, and increased hospital costs [ 10 , 11 ] in patients with viral CAP. Moreover, it was found to be an independent predictor of 2-year mortality after discharge in the elderly patients [ 12 ]. However, the relatively small sample sizes of these studies raise concern for sample bias.…”

Nutritional Support in Coronavirus 2019 Disease

“…Data concerning patients with CAP show that 39% of persons admitted to hospitals are malnourished and their nutritional status may serve as both short and long-term prognostic factord of mortality especially among the elderly [ 11 ]. To add, low albumin level was associated with higher 30-day and 2.5-year mortality rates [ 12 ].…”