Impact of Malnutrition Status at Admission on Post-discharge Short Term Mortality in Palliative Care Unit

Objective: Malnutrition is an immense problem and highly prevalent in patients admitted to palliative care units. We aimed to determine the impact of nutritional status at admission and the risk factors for short-term (90-day) mortality after discharge. Materials and Methods: This study included patients admitted to and discharged from the palliative care unit (PCU). A total of 118 patients were classified into two groups: Patients who died within 3-month after hospital discharge and patients who survived in the same period. The nutrition status of the patients was retrospectively assessed with NRS-2002. Results: The mean age of the patients was 70.9 +/- 13.4. The overall post-discharge 90-day mortality was 40% (n=47). Age, gender, and length of stay in PCU were similar between the two groups. Majority of patients (97.5%) had an NRS score of 3 or above, and 70 patients (59%) had pressure ulcers at admission. Seventy-six patients (64%) were discharged with enteral nutrition (percutaneous endoscopic gastrostomy/nasogastric tube), and the rest were on oral nutrition. Nutritional risk score 2002 (NRS) and pressure ulcer rate on admission were higher in patients with 90-day mortality [4 (3-6) vs. 3 (2-5), p <= 0.001 and 36 (76.6%) vs. 34 (47.9%), p=0.002, respectively]. In addition, patients had lower both systolic and diastolic blood pressure measurements on admission in the mortality group [108 +/- 12.8 vs. 118.6 +/- 14.2, p <= 0.001 and 67.2 +/- 9.5 vs. 72.8 +/- 9.5, p=0.002, respectively]. When patients were divided into two groups, 28.8% were terminally ill. Length of hospitalization in the palliative care unit, discharge with enteral nutrition, and frequency of percutaneous endoscopic gastrostomy was lower; however, the number of patients with malignity, NRS 2002 score, and ninety-day post-discharge mortality was higher in the terminally ill group than in those non-terminally ill. At admission, high NRS 2002 score [odds ratio (OR): 4.03, 95% confidence interval (CI): 1.54-10.52; p=0.005] and low systolic blood pressure (OR: 0.94, 95% CI: 0.90-0.98; p=0.008) were independently associated parameters with short-term (90-day) mortality after discharge in multivariable analysis. Conclusion: In addition to comorbid diseases, hemodynamic findings and nutritional status on admission may be associated with early postdischarge mortality in patients hospitalized in PCU.