Evaluation of Nutritional Support and In-Hospital Mortality in Patients With Malnutrition

Abstract

Question Is nutritional support as prescribed in clinical practice associated with a mortality benefit among patients with malnutrition? Findings In this cohort study of 69 934 patients with malnutrition in a nationwide Swiss claims database, the in-hospital mortality rate was significantly lower among patients receiving nutritional support compared with those not receiving nutritional support. Meaning This study found that nutritional support was associated with a mortality benefit, highlighting the importance of nutritional support for patients in the hospital with malnutrition. This cohort study examines the association of nutritional support with mortality rates among hospitalized patients with malnutrition in Switzerland. Importance Malnutrition affects a considerable proportion of patients in the hospital and is associated with adverse clinical outcomes. Recent trials found a survival benefit among patients receiving nutritional support. Objective To investigate whether there is an association of nutritional support with in-hospital mortality in routine clinical practice. Design, Setting, and Participants This cohort study was conducted from April 2013 to December 2018 among a population of patients from Swiss administrative claims data. From 114 264 hospitalizations of medical patients with malnutrition, 34 967 patients (30.6%) receiving nutritional support were 1:1 propensity score matched to patients with malnutrition in the hospital who were not receiving nutritional support. Patients in intensive care units were excluded. Data were analyzed from February 2020 to November 2020. Exposures Receiving nutritional support, including dietary advice, oral nutritional supplementation, or enteral and parenteral nutrition. Main Outcomes and Measures The primary outcome was all-cause in-hospital mortality. Secondary outcomes were 30-day all-cause hospital readmission and discharge to a postacute care facility. Poisson and logistic regressions were used to estimate incidence rate ratios (IRRs) and odds ratios (ORs) of outcomes. Results After matching, the study identified 69 934 hospitalizations of patients coded as having malnutrition in the cohort (mean [SD] age, 73.8 [14.5] years; 36 776 [52.6%] women). Patients receiving nutritional support, compared with those not receiving nutritional support, had a lower in-hospital mortality rate (2525 of 34 967 patients died [7.2%] vs 3072 of 34 967 patients died [8.8%]; IRR, 0.79 [95% CI, 0.75-0.84]; P < .001) and a reduced 30-day readmission rate (IRR, 0.95 [95% CI, 0.91-0.98]; P = .002). In addition, patients receiving nutritional support were less frequently discharged to a postacute care facility (13 691 patients [42.2%] vs 14 324 patients [44.9%]; OR, 0.89 [95% CI, 0.86-0.91]; P < .001). Conclusions and Relevance These findings suggest that nutritional support was associated with reduced mortality among patients in the medical ward with malnutrition. The results support data found by randomized clinical trials and may help to inform patients, clinicians, and authorities regarding the usefulness of nutritional support in clinical practice.