Endocrine Abstracts

Background: Malnutrition has been associated with increased adverse clinical outcomes and affects a considerable proportion of hospitalized medical patients. While recent evidence from clinical trials revealed a survival benefit from nutritional support, data from a large real-world population is still missing.

Methods: In this population-based cohort study, using a Swiss administrative claims database from January 2012 to December 2017, we created a medical inpatient cohort of malnourished patients and matched patients on nutritional support 1:1 on propensity score. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were length of hospital stay, 30-day all-cause hospital readmission, and discharge to a post-acute care facility. We performed sensitivity analyses by stratification for degree of malnutrition.

Results: After propensity score matching, we identified 56’822 cases in the cohort. Patients receiving nutritional support compared with matched controls had a significantly lower in-hospital mortality (2’178 of 28’411 [7.7%] vs 2’490 of 28’411 [8.8%]; OR 0.86 [95% CI, 0.81 to 0.92], P < 0.001). Malnourished patients on nutritional support faced a 2.5-day longer hospitalization (95% CI 2.3 to 2.7, P < 0.001). All-cause 30-day readmission rate was significantly lower in the intervention group (17.2% vs 18.4%; OR 0.92 [95% CI, 0.88 to 0.97], P < 0.001) but there was no difference in the frequency of discharge to post-acute care facility (45.4% vs 44.9%; OR 1.02 [95% CI, 0.98 to 1.06], P = 0.286). Sensitivity analyses showed an even more pronounced reduction in risk of in-hospital mortality among patients with severe malnutrition (OR 0.71 [95% CI, 0.61 to 0.83], P _{for interaction} = 0.009).

Conclusions: In this large cohort study, nutritional support was associated with a lower risk of in-hospital mortality in direct comparison with malnourished medical patients without nutritional support as treated in routine care. These findings are in line with previous controlled data and will help to inform patients, practitioners and authorities regarding the effectiveness of nutritional support in clinical practice.