Ability to predict six-month mortality and inter-tool agreement between four nutritional assessment instruments in the SAFES cohort

Abstract

AimTo measure the ability to predict 6-month mortality of several different instruments for evaluating nutrition, and to compare agreement between results obtained with these different instruments. MethodsProspective, multi-centre cohort study, including subjects aged 75 years or older, admitted to hospital through the emergency room. The predictive capacity of the different nutrition instruments (namely: Mini Nutritional Assessment (MNA), Geriatric Nutritional Risk Index (GNRI), body mass index (BMI) and albuminemia) were tested using a Cox model after adjustment for socio-demographic and clinical variables. Agreement between these four instruments was assessed by calculating Cohen's Kappa coefficient. ResultsIn total, 1306 subjects were included in the cohort, average age 85±6 years. The crude death rate at 6 months was 24.4%. Prevalence of malnutrition varied from 24 to 59%. All the nutrition instruments evaluated were significantly related to survival; the strongest associations with mortality were observed with GNRI (hazard ratio [HR]=1.65; 95% CI= 1.31–2.06) and MNA (HR=1.64; 95% CI=1.27–2.03). Agreement between indicators was moderate to poor. ConclusionThe GNRI and the MNA appear to be the most useful tools for detecting malnutrition in elderly patients admitted via the emergency room.