The Effect of Malnutrition at Admission on Length of Hospital Stay among Adult Patients in Tikur Anbessa Specialized Hospital Addis Ababa, Ethiopia: A Cohort Study

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Addis Abeba University


Background:Malnutrition in hospitalized adults is a highly prevalent problem. The worldwide prevalence of malnutrition in hospitals ranges from 15–54%. Hospital malnutrition is associated with delays in recovering from illness, increased cost of care, complications, increased the length of stay, mortality and poor quality of life compared to well-nourished patients. In hospitals, length of stay (LOS) is a priority concern but it may be prolonged by malnutrition through its effect on immune functions, wound healing process and greater risk of complications. Amidst the high rates of malnutrition documented worldwide and its associated consequences, little is known on clinical adverse outcomes like prolonged length of hospital stay in the Ethiopian hospital setting Objective:The study aimedto evaluate the effect of malnutrition at the time of admission on the length of hospital stay among adult patients in TikurAnbessa Specialized Hospital, Ethiopia Method:A prospective cohort study was conducted among hospitalized adult patients, who were admitted to Tikur Anbessa specialized hospital medical or surgical wards ,with a minimum length of stay of 24 hours were recruited. Proportional allocation and Consecutive sampling method were used to select patients. At admission, Patients Nutritional statuswere assessed within 48 h using the Subjective Global Assessment (SGA).The main clinical outcome Length of stay in hospital (LOS) was captured for every patient in days. Socio demographic, economic and admission related Patient clinical Characteristics were included .Data were compiled, checked, coded ,entered and cleaned using Epi Data 4.4.1 and all statistical tests were done using STAT version 15.1 software. Descriptive statistical tests and multivariate Cox’s regression model was used to investigate the effect of malnutrition on the length of hospital stay after adjusted for several potential nutritional and clinical confounders recorded at admission. Results are expressed as hazard ratios (HR) and their 95% CI. Result: On admission a total of 417 patients , predominantly male (54.2%), were included. The mean age was 38 ± 16 years. Using Subjective Global Assessment (SGA), the magnitude of malnutrition was 62.1%(95% CI: 57.3%, 66.6%) . The mean length of stay was 13.84 days ± 7.53SD, with a significant difference (p<0.01) in length of stay between malnourished patients and well-nourished patients. Malnourished patients had longer hospital stays (17.2± 6.8 days vs. 8.3±4.9 days, p< 0.001).The final multivariate model, which was controlled for age, sex, living conditions, number of medications, and number of diagnostic categories, disease severity score, number of comorbidities and presence of cancer showed that malnutrition (SGA B+C) at admission was independently associated with prolonged LOS (HR, 0.29; 95% CI, 0.22–0.38) Conclusion:The study showed that malnutrition was highly prevalent among hospitalized adult patients and was associated with increased length of stay. The rate of malnutrition tended to be high when the patient was older than 60 years old . Malnourished patients needed longer hospitalization in the present study. More attention should be paid to nutrition in both medical and surgicalpatients.Therefore, it’s essential to assess the nutritional status of patients early in admission and to institute appropriate nutritional therapy to minimize its devastating consequences on the patients and health care system.



Malnutrition,Adult Patients