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

Background: We hypothesized that preexisting malnutrition in patients who survived critical care would be associated with adverse outcomes following hospital discharge. Methods: 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. Results: 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. Conclusions: In patients treated with critical care who survive hospitalization, preexisting malnutrition is a robust predictor of subsequent mortality and unplanned hospital readmission.