Authors (including presenting author) :
THY Ting(1), SHY Chan(1), EKH Luk(1), QMY To(1), CY Wong(1), KL CHOO(2)
Affiliation :
(1) Dietetics Department, North District Hospital, Hong Kong, China (2) Department of Medicine, North District Hospital, Hong Kong, China
Introduction :
Hospital malnutrition is extremely common, with a prevalence ranging from 9.2 to 50% in hospitalised patients. However, patients with chronic disease such as Chronic Obstructive Pulmonary Disease (COPD) are suggested to have higher rates compared to other patients. Studies suggested that 10 to 60% of COPD patients are undernourished. Chronic obstructive pulmonary disease, as defined by The Global Initiative for Chronic Obstructive Lung Disease (GOLD), is characterised by progressive airflow obstruction and may not be fully reversible. It is associated with an enhanced chronic inflammatory response in the airways and is the third most common cause of death globally. A poor nutritional status in COPD patients is closely related to increased complications, increased healthcare cost, prolonged length of hospital stay, increased mortality and increased hospital admission.
Objectives :
This retrospective cohort study aimed to determine the malnutrition prevalence, nutritional intake and clinical outcomes of patients at a hospital in Hong Kong.
Methodology :
Electronic dietetics records of COPD patients who have seen a dietitian for nutrition support were retrieved for the admission period from 1st Apr 2017 to 31 Mar 2019. A total of 180 patients with the principal diagnosis of COPD were retrieved for analysis. Prevalence of malnutrition, mortality, length of stay (LOS) and the 28-day emergency readmission rate after discharge were compared among different risk groups. Among these 180 COPD patient records, 156 contained energy and protein intake records. The actual energy and protein intakes were compared among different risk groups. Nutrition intake adequacy was investigated by comparing actual intake and estimated nutritional requirements. Of the 180 COPD patient records, 88 had both body and height records. The body mass index values of these 88 patients were compared among the different risk groups. One-way ANOVA, independent t test and Pearson´s chi-square test were used to analyse the outcomes and to compare the variable means.
Result & Outcome :
The prevalence of malnutrition risk among these 180 COPD patients was 77.8%. The LOS of patients with malnutrition risk was 59% longer than the low risk group (8.9±11.8days vs. 5.6±3.4days, p< 0.05). The emergency readmission rate within 28 days was higher in the at-risk patients compared to low-risk patients (37.5% vs. 20.0%, OR=2.44, p< 0.05), as was the mortality rate (5.0% vs. 0%, OR 4.55, p< 0.05). Eighty-eight patients have Body Mass Index (BMI) records, 60% of them were underweight with BMI ≤18.5 kg/m2, in which 26% were categorized as severely underweight (BMI≤16.0 kg/m2). One hundred fifty-six subjects have energy and protein intake records. The mean intakes were 839kcal and 37g respectively, meeting only 59% and 64% of their requirements.
