Predictability of deterioration in marginally malnourished cancer patients during hospitalisation

Abstract

One hundred and twenty-six cancer patients admitted consecutively to the Istituto Nazionale Tumori, Milan, were examined. Within 48 h of hospital admission and again after one week, each patient underwent a nutritional assessment including standard anthropometric and biochemical indices (weight loss, serum proteins, serum albumin, total iron binding capacity (TIBC), cholinesterase (CHE) and lymphocyte count). Calorie and protein intake were also calculated. Each patient was classified with respect to a threshold of normality for each variable (< 10% for weight loss, > 6 g/dL for serum proteins, ⩾ 3.4 g/dL for serum albumin, ⩾ 250 mmg/dL for TIBC, ⩾ 1900 mU/dL for CHE, ⩾ 1500/nm for total lymphocytes count and ⩾ 90% Recommended Dietary Allowances (RDA) for nutritional intake). The Mann-Whitney test was performed to assess the statistical significance of the variation between all the nutritional variables at admission and after 7 days of hospitalisation. The relative risk of developing malnutrition regarding a nutritional index after 7 days of hospitalisation was then calculated with reference to each nutritional variable at admission. The significance was tested by the chi square test. The analysis showed that patients who developed deterioration of a nutritional index during hospitalisation had, at admission, worse values of the variable which subsequently deteriorated. In particular, low levels of serum albumin and total iron binding capacity were the variables associated with the higher number of nutritional indices which deteriorated after 7 days of hospitalisation. These were followed by low values of cholinesterase, body weight, serum proteins and lymphocytes. No significant relationship was found between change of a nutritional variable and protein and calorie intake. The risk of developing relevant weight loss (relative risk (RR) = 3.52), hypoalbuminemia (RR = 2.38) and hypoproteinemia (RR = 2.6) during hospitalisation was significantly higher when CHE was below 1900 mU/mL at admission.