1. HOSPITAL MALNUTRITION IN CATALONIA, SPAIN:
AN INITIATIVE OF THE HOSPITAL MALNUTRITION GROUP
INTRODUCTION
RATIONALE
Catalonia is a Spanish autonomous community, with a population of 7 million inhabitants. A high percentage of persons hospitalized in Catalonia are malnourished or in risk of malnutrition. In 2006 the Working Group of Hospital Malnutrition in Catalonia was born. It is composed by representatives of eleven hospitals (7 Reference Hospitals and 4 Second Level Hospitals, hospital beds, population of reference: about 5 million inhabitants) which investigates how to improve the nutritional status of our patients. This group works in a voluntary way to determine by consensus the best protocol to fight malnutrition in our population.
To know the prevalence of hospital malnutrition at hospital admission in a representative population of Catalonian Hospitals. We wanted to verify the usefulness of the Nutritional Risk Screening 2002 (NRS-2002) as a screening tool for detection undernutrition in our population
- To know the relation between malnutrition and demographic information (age, gender, social level), co-morbidities and economic scores (length of hospital stay, need of Home Care), as well as the relation between malnutrition and mortality.
METHODS
CONSIDERED VARIABLES
NRS-2002
Age, gender, BMI, diagnosis of the disease that motivates the hospital admission.
Social Class estimated according to the classification of the Spanish Society of Epidemiology based on the occupation.
Charlson co-morbidity Index (reflects the clinical complexity of the patient)
Hospital stay in days.
Destination of the patient at discharge (home, Home Care or death)
Prospective and random study including patients admitted in hospital the previous hours. We excluded paediatric, obstetric and critical units. The size of the sample was calculated considering an estimated prevalence of 30-35%.
Patients were included in proportion to total hospital beds and stratified by Services in order to represent all the Services of the participant Hospitals.
The study was carried between January-December 2007.
RESULTS
PATIENTS: n = 796 patients were studied; 44.8% female. Mean BMI 26.4 ± 5.5. Mean age 66 y ( y)
Positive
n = 481 (60.4%)
Positive
n = 230 (47.8%)
UNDERNUTRITION AT HOSPITAL ADMISSION
230 / 796 (28.9%)
FINAL NRS
n = 481
INITIAL SCREENING
n = 796
Negative
n = 315 (39.6%)
Negative
n = 251 (52.2%)
Positive
NRS
Negative p
Age
68.5 ± 16
59.6 ± 17
p = 0.001
Charlson’s index
2.78 ± 2,1
1.5 ± 1.7
p <
Length of stay
10.5 ± 9.5
7.7 ± 7.8
Medical / Surgical
39 % / 19,6 %
61 % / 80.4 %
Type of hospital admission
Scheduled 22.3 %
Emergency 34.3 %
Scheduled 78.7%
Emergency 65.7%
Social class
Manual 26 %
Qualified 34 %
Manual 74 %
Qualified 66 %
p =0.003
Location
at discharge
Home 83.6 %
Home Care 7.8 %
Death 8.6 %
Home 94.5 %
Home Care 4.3 %
Death1.3 %
TYPE OF HOSPITAL ADMISSION
Emergency admissions RR 1.39 (IC 95% 0.8 –2.0) p = 0.08 (NS)
p <0.0001
p = 0.007
MEDICAL VS SURGICAL SPECIALITIES
Medical specialities RR 1.82 (IC 95% 1.26 –2.63) p = 0.001
Second Level Hospitals
Third level hospitals p
Age
64.3 ± 18.7
61.8 ± 17 NS
BMI
26.7 ± 5.2
26.3 ± 5.5
Gender
49.7 % Female
50.3 % Female
Length of stay
8.7 ±7.0
8.6 ± 8.7
Medical / Surgical
M 49.7 %
S 50.3 %
M 48.6 %
S 51.4 %
Charlson´s index
1.58
1.94
p = 0.039
Type of hospital admission
Emergency 70 %
Emergency 54.5 %
p <
Social class
Manual 80 %
Manual 69 %
p = 0.003
Location
at discharge
Home 88.8 %
Home Care 10 %
Death 1.3 %
Home 91.9 %
Home Care 4.1 %
Death 4 %
p = 0.004
p <
p = 0.002
PACIENT DESTINY AT DISCHARGE
p =
p = 0.023
p < 0.001
CONCLUSIONS
A high percentage of patients presents a positive initial screening.
The complete screening detects malnutrition or risk of malnutrition in 28.7 % of the patients, being greater in the hospitals of the third level of assistance.
The profile of patients at higher risk are: admitted from emergency room, admitted in a medical service, qualified worker, with co-morbidities, and with diagnosis of hemato-oncological disease.
The patients who present a positive screening have: greater length of stay in hospital, greater mortality and need of Home Care at discharge.
Given the great simplicity of the screening, it should be considered for implementation at hospital admission in all patients.
This is the first large national study of malnutrition prevalence.
NEXT STEPS: To investigate the economical impact of the detection and treatment of hospital malnutrition.
Multivariate analysis:
SECOND LEVEL RR 0.45 (IC 95% 0.29 –0.73) p= 0.001
SOCIAL CLASS: Manual workers RR 0.63 (IC 95 % 0.44 – 0.91) p <
CHARLSON´S INDEX: RR 1.26 (IC 95 % 1.16 – 1.37) p <
AGE: RR 1.03 (IC 95 % ) p <
HAEMATO-ONCOLOGICAL DIAGNOSIS: RR 2.16 (IC 95% 1.47 –3.1) p <
REFERENCES
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening Clin Nutr 2003; 22 (4):
Planas M, Audivert S, Perez-Portabella C, Burgos R, Puiggros C, Casanelles JM, Rossello J. Nutritional status among adult patients admitted to an university-affiliated hospital in Spain at the time of genoma. Clin Nutr 2004; 23 (5):
ACKNOWLEDGEMENTS:
We are grateful to Grifols laboratories for their assistance and financing of this project
The Spanish Society for Parenteral and Enteral Nutrition, SENPE, for supporting the project
All the professional staff that have worked in this group.
CORRESPONDENCE: Dra. Rosa Burgos Peláez. Clinical Nutrition Unit, Endocrinology Service. Hospital Universitari de Bellvitge. Barcelona, Spain.
C/ Feixa Llarga s/n, l’Hospitalet de Llobregat, Barcelona, Spain. Tlf Mail address: