THE PROGNOSTIC-SIGNIFICANCE OF PROTEIN-ENERGY MALNUTRITION IN GERIATRIC-PATIENTS

Although it has been shown that protein-energy malnutrition is a predi ctor of adverse outcome in geriatric patients, it is unclear whether t his is due to underlying disease or disability, or whether malnutritio n is an independent outcome predictor. To clarify the predictive role of malnutrition, we analysed the 4.5-year mortality and living locatio n follow-ups of 219 geriatric patients admitted to a geriatric assessm ent unit. Prevalence of anthropometric and serological malnutrition in dicators were between 13.7% and 39.8% at hospital admission. In bivari ate models, prealbumin, subnormal arm muscle area, and subnormal body weight were predictors of mortality and survival at home. On the other hand, albumin, transferrin, and triceps skin-fold thickness did not p redict these outcomes. In multivariate models the hazard ratio (HR) of 4.5-year mortality remained significant with an HR of 1.8 (95% CI 1.3 -2.6) for subnormal arm muscle area, and 1.6 (95% CI 1.0-2.6) for subn ormal body weight. Prealbumin was the strongest serological outcome pr edictor (multivariate mortality HR 1.9, 95% CI, 1.3-2.8). In these mod els, subnormal cognitive function, impaired physical function, and cre atinine clearance < 30 ml/min were also associated with increased mort ality. Malnutrition did not predict hospital discharge location, but a mong patients discharged home, those with initial malnutrition had a d ecreased length of survival at home. Our findings indicate that certai n protein-energy malnutrition indicators are independent risk factors predicting decreased length of overall survival and survival at home i n geriatric patients. Physicians should screen actively for this often unrecognized problem and initiate appropriate treatment strategies.