THE RISK OF LIFE-THREATENING COMPLICATIONS IN A SELECT POPULATION OF GERIATRIC-PATIENTS - THE IMPACT OF NUTRITIONAL-STATUS

Objective: The primary objective of this study was to assess the inter relationship between protein-energy nutritional status, disease severi ty, and life-threatening complications in a population of elderly reha bilitation patients. Methods: Three-hundred and fifty randomly selecte d admissions to Geriatric Rehabilitation Unit of a Veterans Administra tion hospital were prospectively studied. The average age of the study subjects was 76 years, nearly all(99%) were male, and 75% were white. At admission, each patient completed a comprehensive medical, functio nal, neuropsychological, socioeconomic, and nutritional assessment. Wh ile remaining in the hospital, each subject was monitored on a daily b asis for the development of complications. Results: Of the 96 variable s evaluated, the best predictors of developing at least one life-threa tening complication were serum albumin, body mass index, the presence of renal disease (i.e. blood urea nitrogen >30 mg/L), the Katz Index o f Activities of Daily Living score, and the amount of weight loss in t he year prior to admission. When all of these variables were included in the logistic regression analysis, the final model was highly signif icant by the -2Log Likelihood Chi-square goodness-of-fit criterion (Ch i-square of 64.1 with 5 d.f., p < 0.0001) with a sensitivity of 77%, a specificity of 77% and an overall predictive accuracy of 77%. When th e predictive accuracy of the logistic model was tested using a second sample of 110 patients, the model differentiated those who developed a life-threatening complication from those who had not with a sensitivi ty of 88%, a specificity of 61%, and an overall predictive accuracy of 65%. As indicated by the Chi-square test, these results were signific ant (p < 0.0001). Conclusions: Protein-energy undernutrition appears t o be a strong independent risk factor for life-threatening morbidity d uring hospitalization.