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Clinical nutrition, enteral and parenteral nutrition

Is undernutrition risk associated with an adverse clinical outcome in spinal cord-injured patients admitted to a spinal centre?

European Journal of Clinical Nutrition volume 68, pages 125–130 (2014)Cite this article

Subjects

Abstract

Background/objectives:

To evaluate whether undernutrition risk measured using the Spinal Nutrition Screening Tool (SNST) and the Malnutrition Universal Screening Tool (MUST) is associated with worse clinical outcomes in respect of length of in-patient hospital stay (LOS) and mortality in the 12 months after admission to a spinal cord injuries (SCIs) centre.

Methods:

A multicentre, prospective, cross-sectional observational study was conducted in four UK SCI centres (SCICs). A total of 150 SCI patients (aged 18–88 years (median: 44 years), 30.7% females) were studied between July 2009 and March 2010. LOS and mortality 12 months after admission to the SCIC was monitored. Multivariate regression analysis was used to identify unique predictors of the variance of LOS.

Results:

The patients initially undernourished or at risk of undernutrition (44.6%) had a significantly longer LOS (median (days): 129 vs 85, P=0.012) and greater 12-month mortality (% deceased: 9.2% vs 1.4%, P=0.036). In addition, serum albumin and new admission to an SCIC were identified as independent predictors for long LOS.

Conclusion:

The present study suggests that undernutrition risk, as identified by the SNST, is associated with adverse clinical outcomes. Nutritional screening should be helpful in improving clinical outcomes if it promotes more appropriate and effective nutritional intervention.

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References

  1. Wong S, Derry F, Jamous A, Hirani SP, Grimble G, Forbes A . The prevalence of malnutrition in spinal cord injured patients - a UK multicentre study. Br J Nutr 2012; 108: 918–923.

    Article  CAS  Google Scholar 

  2. Wong S, Graham A, Hirani SP, Grimble G, Forbes A . Profile and prevalence of malnutrition in children with spinal cord injuries - assessment of the Screening Tool for Assessment in Paediatrics (STAMP). Spinal Cord 2012; 50: 67–71.

    Article  CAS  Google Scholar 

  3. Schneider SM, Veyres P, Pivot X, Soummer AM, Jambou P, Filippi J et al. Malnutrition is an independent factor associated with noscomial infections. Br J Nutr 2004; 92: 105–111.

    Article  CAS  Google Scholar 

  4. Ho CH, Powell HL, Collins JF, Bauman WA, Spungen AM . Poor nutrition is a relative contraindication to negative pressure wound therapy for pressure ulcers: preliminary observations in patients with spinal cord injury. Adv Skin Wound Care 2010; 23: 508–516.

    Article  Google Scholar 

  5. National Institute of Health and Clinical Excellence. The management of pressure ulcers in primary and secondary care: A clinical practice guideline. NICE: London, UK, 2005.

  6. Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krahenbihl L, Meier R et al. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 2008; 27: 340–349.

    Article  Google Scholar 

  7. National Institute of Health and Clinical Excellence. Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. NICE: London, UK, 2006.

  8. Royal College of Physicians. Chronic Spinal Cord Injury: management of patients in acute hospital setting: National Guidelines. Royal College of Physicians: London, UK, 2008.

  9. Elia M . Screening for Malnutrition: A multidisciplinary Responsibility. Development and Use of the Malnutrition Universal Screening Tool (MUST) for adults. BAPEN: Redditch, UK, 2003.

    Google Scholar 

  10. Kruizenga HM, Seidell JC, de Vet HCW, Wierdsma NJ, van Bokhorst-de van der Schueren MA . Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr 2005; 24: 75–82.

    Article  CAS  Google Scholar 

  11. Morgan MY, Madden AM, Soulsby CT, Morris RW . Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis. Hepatology 2006; 44: 823–835.

    Article  Google Scholar 

  12. Wong S, Derry F, Jamous A, Hirani SP, Grimble G, Forbes A . Validation of the Spinal Nutrition Screening Tool (SNST) in patients with spinal cord injuries (SCI) - result form a multicentre study. Eur J Clin Nutr 2012; 66: 382–387.

    Article  CAS  Google Scholar 

  13. Stratton RJ, Green CJ, Elia M . Disease-related Malnutrition: an evidence-based approach to treatment. CABI Publishing: Oxford, 2003.

    Book  Google Scholar 

  14. Correia MI, Waitzberg DL . The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003; 22: 235–239.

    Article  Google Scholar 

  15. Daverat P, Gagon M, Dartigues JF, Mazaus JM, Barat M . Initial factors predicting survival in patients with a spinal cord injury. J Neurol Neurosurg Psychiatry 1989; 52: 403–406.

    Article  CAS  Google Scholar 

  16. Burr RG, Clift-Peace L, Nuseibeh I . Haemoglobin and albumin as predictors of length of stay of spinal injured patients in a rehabilitation centre. Paraplegia 1993; 31: 473–478.

    CAS  PubMed  Google Scholar 

  17. Naber TH, Schermer T, de Bree A, Nusteling K, Eggink L, Kruimel JW et al. Prevalence of malnutrition in nonsurgical hospitalised patients and its association with disease complication. Am J Clin Nutr 1997; 66: 1232–1239.

    Article  CAS  Google Scholar 

  18. Hennessey DB, Burke JP, Ni-Dhonochu T, Shields C, Winter DC, Mealy K . Preoperative hypoalbuminemia is an independent risk factor for the development of surgical site infection following gastrointestinal surgery. Ann Surg 2010; 252: 325–329.

    Article  Google Scholar 

  19. Franch-Arcas G . The meaning of hypoalbuminaemia in clinical practice. Clin Nutr 2001; 20: 265–269.

    Article  CAS  Google Scholar 

  20. Joint Standard Development Groups of the South England Review Group. Standard for patients requiring spinal cord injury care (Revised 2010). http://www.sci-link.org.uk/wp-content/uploads/2010/09/Standards_SCI_final_May_20101.pdf. Accessed 20 November 2010.

  21. Wong S, Derry F, Grimble G, Forbes A . How do spinal cord injury centre manage malnutrition? A cross-sectional survey of 12 regional centres in the United Kingdom and Ireland. Spinal Cord 2012; 50: 132–135.

    Article  CAS  Google Scholar 

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Acknowledgements

We are pleased to acknowledge the support from the UK National Institute for Health Research (NIHR) via its funding of the University College London (UCL) Biomedical Research Centre. We would like to thank the patients and ward staff for participating in the study, Dr Allison Graham for reviewing the manuscript and Pauline Bateman at the National Spinal Injuries Centre at Stoke Mandeville Hospital. We would like to thank the staff of different SCI centres for their kind support in the different hospitals participating in the study. The study group included Dr Joan Gandy, The British Dietetic Association; Anthony Twist, The Robert Jones and Agnes Hunt Orthopaedics and District Hospital, Oswestry, UK; Philippa Bearne, Salisbury District Hospital, Salisbury, UK; and Dr Angela Gall and Judith Susser, Royal National Orthopaedic Hospital, Stanmore, UK. We are also grateful to Abbott Nutrition for providing an unrestricted grant to fund this study. The sponsors of the study did not have any role in the study design, data collection, analysis and interpretation, writing of the paper or in the decision to submit the paper for publications.

Author contributions

SW contributed to protocol development, data collection, data analysis, manuscript preparation. FD helped in clinical supervision, manuscript revision. AJ provided clinical supervision, manuscript revision. SPH contributed to statistical supervision, manuscript revision. SPH helped in statistical supervision, manuscript revision. AF contributed to academic supervision, manuscript revision and guarantor. All authors have read and approved the final version submitted for publication.

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Authors and Affiliations

  1. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK

    S Wong, F Derry & A Jamous

  2. School of Health Sciences, City University, London, UK

    S Wong & S P Hirani

  3. Centre for Gastroenterology and Clinical Nutrition, University College, London, UK

    S Wong & A Forbes

Authors
  1. S Wong
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  2. F Derry
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  3. A Jamous
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  4. S P Hirani
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  5. A Forbes
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Corresponding author

Correspondence to S Wong.

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The authors declare no conflict of interest.

Additional information

Part of the study result was presented at the International Spinal Cord Society annual meeting in London, September 2012, and at the European Society of Parenteral and Enteral Nutrition annual meeting in Barcelona, September 2012.

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Wong, S., Derry, F., Jamous, A. et al. Is undernutrition risk associated with an adverse clinical outcome in spinal cord-injured patients admitted to a spinal centre?. Eur J Clin Nutr 68, 125–130 (2014). https://doi.org/10.1038/ejcn.2013.238

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