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

Abstract

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 114264 hospitalizations of medical patients with malnutrition, 34967 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 69934 hospitalizations of patients coded as having malnutrition in the cohort (mean [SD] age, 73.8 [14.5] years; 36776 [52.6%] women). Patients receiving nutritional support, compared with those not receiving nutritional support, had a lower in-hospital mortality rate (2525 of 34967 patients died [7.2%] vs 3072 of 34967 patients died [8.8%]; IRR, 0.79 [95% CI, 0.75-0.84]; P