-
1
المؤلفون: Filomena Gomes, Manuela Deiss, Silvia Mattmann, Philipp Schuetz, Nina Kaegi-Braun, Nicolas Rodondi, Alexander Kutz, Christoph Henzen, Claus Hoess, Michael Brändle, Carmen Benz, Jacques Donzé, Stefan Bilz, Zeno Stanga, Sarah Sigrist, Drahomir Aujesky, Pascal Tribolet, Sarah Schmid, Valerie Baechli, Beat Mueller, Martina Geiser, Robert Thomann, Vojtech Pavlicek, Thomas Bregenzer, Rebecca Fehr, Jonas Rutishauser
المصدر: Kaegi-Braun, Nina; Tribolet, Pascal; Gomes, Filomena; Fehr, Rebecca; Baechli, Valerie; Geiser, Martina; Deiss, Manuela; Kutz, Alexander; Bregenzer, Thomas; Hoess, Claus; Pavlicek, Vojtech; Schmid, Sarah; Bilz, Stefan; Sigrist, Sarah; Brändle, Michael; Benz, Carmen; Henzen, Christoph; Mattmann, Silvia; Thomann, Robert; Rutishauser, Jonas; ... (2021). Six-month outcomes after individualized nutritional support during the hospital stay in medical patients at nutritional risk: Secondary analysis of a prospective randomized trial. Clinical nutrition, 40(3), pp. 812-819. Elsevier 10.1016/j.clnu.2020.08.019 <http://dx.doi.org/10.1016/j.clnu.2020.08.019>
مصطلحات موضوعية: 0301 basic medicine, Male, medicine.medical_specialty, Activities of daily living, Nutritional Status, 610 Medicine & health, 030209 endocrinology & metabolism, Critical Care and Intensive Care Medicine, Patient Readmission, law.invention, 03 medical and health sciences, 0302 clinical medicine, Quality of life, Randomized controlled trial, 360 Social problems & social services, law, Risk Factors, Intervention (counseling), Activities of Daily Living, Clinical endpoint, medicine, Humans, Mortality, Aged, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Nutritional Support, Mortality rate, Hazard ratio, Malnutrition, medicine.disease, Hospitalization, Emergency medicine, Quality of Life, Accidental Falls, Female, Dietary Proteins, business, Energy Intake
الوصف: Summary Background Among medical inpatients at risk of malnutrition, the use of individualized nutritional support during the hospital stay was found to reduce complications and improve mortality at short-term. We evaluated clinical outcomes at 6-months follow-up. Methods We randomly assigned 2028 patients to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or hospital food as usual (control group) during the hospital stay. The intervention was discontinued at hospital discharge and further nutritional support was based on the discretion of the treating team. We had complete follow-up information of 1995 patients (98%), which were included in the final analysis. The primary endpoint was all-cause mortality at 6-months. Prespecified secondary end points included non-elective hospital readmissions, functional outcome and quality of life. Results At 6-month, 231 of 994 (23.2%) intervention group patients had died compared to 246 of 999 (24.6%) control group patients, resulting in a hazard ratio for death of 0.90 (95%CI 0.76 to 1.08, p = 0.277). Compared to control patients, intervention group patients had similar rates of hospital readmission (27.3% vs. 27.6%, HR 1.00 (95%CI 0.84 to 1.18), p = 0.974), falls (11.2% vs. 10.9%, HR 0.96 (95%CI 0.72 to 1.27), p = 0.773) and similar quality of life and activities of daily living scores. Interpretation While individualized nutritional support during the hospital stay significantly reduced short-term mortality, there was no legacy effect on longer term outcomes. Future trials should investigate whether continuation of nutritional support after hospital discharge reduces the high malnutrition-associated mortality rates in this vulnerable patient population. Trial registration ClinicalTrials.gov number, NCT02517476.
وصف الملف: application/pdf
-
2
المؤلفون: Christoph Henzen, Carmen Benz, Rebecca Fehr, Jonas Rutishauser, Philipp Schuetz, Thomas Bregenzer, Valerie Baechli, Claus Hoess, Manuela Deiss, Nina Braun, Filomena Gomes, Pascal Tribolet, Michael Brändle, Robert Thomann, Jacques Donzé, Sarah Schmid, Silvia Mattmann, Alexander Kutz, Stefan Bilz, Beat Mueller, Vojtech Pavlicek, Sarah Sigrist, Martina Geiser, Claudia Brand, Drahomir Aujesky, Nicolas Rodondi, Zeno Stanga
المصدر: Lancet (London, England). 393(10188)
مصطلحات موضوعية: Male, medicine.medical_specialty, Comorbidity, 030204 cardiovascular system & hematology, Risk Assessment, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Intensive care, Patient-Centered Care, Outcome Assessment, Health Care, medicine, Clinical endpoint, Humans, 030212 general & internal medicine, Medical nutrition therapy, 610 Medicine & health, Aged, Aged, 80 and over, business.industry, Nutritional Support, Malnutrition, General Medicine, Odds ratio, Middle Aged, medicine.disease, Clinical trial, Hospitalization, Emergency medicine, Acute Disease, Chronic Disease, Practice Guidelines as Topic, Female, Risk assessment, business, Energy Intake, 360 Social problems & social services
الوصف: Summary Background Guidelines recommend the use of nutritional support during hospital stays for medical patients (patients not critically ill and not undergoing surgical procedures) at risk of malnutrition. However, the supporting evidence for this recommendation is insufficient, and there is growing concern about the possible negative effects of nutritional therapy during acute illness on recovery and clinical outcomes. Our aim was thus to test the hypothesis that protocol-guided individualised nutritional support to reach protein and caloric goals reduces the risk of adverse clinical outcomes in medical inpatients at nutritional risk. Methods The Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) is a pragmatic, investigator-initiated, open-label, multicentre study. We recruited medical patients at nutritional risk (nutritional risk screening 2002 [NRS 2002] score ≥3 points) and with an expected length of hospital stay of more than 4 days from eight Swiss hospitals. These participants were randomly assigned (1:1) to receive either protocol-guided individualised nutritional support to reach protein and caloric goals (intervention group) or standard hospital food (control group). Randomisation was done with variable block sizes and stratification according to study site and severity of malnutrition using an interactive web-response system. In the intervention group, individualised nutritional support goals were defined by specialist dietitians and nutritional support was initiated no later than 48 h after admission. Patients in the control group received no dietary consultation. The composite primary endpoint was any adverse clinical outcome defined as all-cause mortality, admission to intensive care, non-elective hospital readmission, major complications, and decline in functional status at 30 days, and it was measured in all randomised patients who completed the trial. This trial is registered with ClinicalTrials.gov , number NCT02517476 . Findings 5015 patients were screened, and 2088 were recruited and monitored between April 1, 2014, and Feb 28, 2018. 1050 patients were assigned to the intervention group and 1038 to the control group. 60 patients withdrew consent during the course of the trial (35 in the intervention group and 25 in the control group). During the hospital stay, caloric goals were reached in 800 (79%) and protein goals in 770 (76%) of 1015 patients in the intervention group. By 30 days, 232 (23%) patients in the intervention group experienced an adverse clinical outcome, compared with 272 (27%) of 1013 patients in the control group (adjusted odds ratio [OR] 0·79 [95% CI 0·64–0·97], p=0·023). By day 30, 73 [7%] patients had died in the intervention group compared with 100 [10%] patients in the control group (adjusted OR 0·65 [0·47–0·91], p=0·011). There was no difference in the proportion of patients who experienced side-effects from nutritional support between the intervention and the control group (162 [16%] vs 145 [14%], adjusted OR 1·16 [0·90–1·51], p=0·26). Interpretation In medical inpatients at nutritional risk, the use of individualised nutritional support during the hospital stay improved important clinical outcomes, including survival, compared with standard hospital food. These findings strongly support the concept of systematically screening medical inpatients on hospital admission regarding nutritional risk, independent of their medical condition, followed by a nutritional assessment and introduction of individualised nutritional support in patients at risk. Funding The Swiss National Science Foundation and the Research Council of the Kantonsspital Aarau, Switzerland.