İç Hastalıkları Servislerinde Hospitalize Edilen Hastaların Malnütrisyon, Kırılganlık ve Komorbid Hastalıklar Açısından Değerlendirilmesi ve Kısa Dönem Sağkalım Üzerine Etkisinin İncelenmesi

Abstract

Malnutrition and frailty are common in hospitalized patients and cause increased complications, prolonged hospital stays, increased mortality and rehospitalization. The aim of our study is to screen inpatients for malnutrition, frailty and comorbid diseases, to reveal the factors associated with these conditions, and to examine these conditions in terms of predicting the duration of hospitalization, their effects on short-term survival and rehospitalization processes. Our study included 134 inpatients aged 50 and over who were followed up due to acute illness in the Internal Medicine services of HUTF Hospital. The demographic, clinical and laboratory characteristics of the participants, their comorbidities, malnutrition, frailty, prolonged hospitalization (>10 days), rehospitalization in the first 3 and 6 months, and mortality rates were evaluated. Mini Nutritional Assessment Short Form (MNA-SF), Nutritional Risk Screening-2002 (NRS-2002) screening tests and Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition, FRAIL scale and clinical frailty scale (CFS) for frailty were used. Hand grip strength (HGS) was measured to measure muscle strength and determine muscle functions in terms of sarcopenia risk. In the presence of a significant "cut-off" value, the sensitivity and specificity of the test were calculated. The relationship of parameters with overall survival was examined using the log-rank test. The average age of the patients included in the study was 67.2 ± 10.4 years, and 55.2% of the patients were 65 years or older. 91.8% of the patients had at least one comorbid disease, and the most common comorbidity was hypertension with 61.2%. The mean score of MNA-SF was 9 ± 2.5, 33.6% of the patients were in the malnutrition category, and 44% of the patients were 3 points or above for NRS-2002. When patients were evaluated according to the GLIM criteria, malnutrition was observed in 44.8% of the patients (29.9% with stage 1 and 14.9% with stage 2). Improper detection of nutritional status by MNA-SF, NRS-2002 and GLIM criteria is associated with prolonged hospitalization (>10 days) (p:0.043, p:0.014, p:0.023) and rehospitalization and mortality rates in the first 3-6 months (p<0.001). According to the FRAIL scale, 53.7% of the patients were evaluated as frail, and according to the clinical frailty scale, 59% of the patients were evaluated as frail. Being frail according to the FRAIL scale and CFS was found to be associated with rehospitalization and death rates in the first 3 months (p:0.027, p:0.007). Each of the methods we used for malnutrition and frailty were associated with 6-month overall survival. Additionally, decreased calf circumference and low hand-grip force were found to be significantly associated with rehospitalization and death in the first 3-6 months after discharge. Early treatment and intervention will be possible by screening for malnutrition and frailty in patients hospitalized due to acute illness during hospitalization. This provided evidence that it could be effective in preventing possible future complications, possible re-hospitalizations and mortality risk.