Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study

Nicola Veronese, Alberto Cella, Alfonso J. Cruz-Jentoft, Maria Cristina Polidori, Francesco Mattace-Raso, Marc Paccalin, Eva Topinkova, Antonio Greco, Arduino A. Mangoni, J. Daragjati, Giacomo Siri, Alberto Pilotto, Clarissa Musacchio, Romina Custureri, Matteo Puntoni, Matteo Simonato, M. Durando, Carmen Miret-Corchado, Beatriz Montero-Errasquin, Anna MeyerDirk Hoffmann, Ralf Joachim Schulz, Lisanne Tap, Angelique Egberts, Marie Laure Bureau, Thomas Brunet, Evelyne Liuu, Helena Michalkova, P. Madlova, Daniele Sancarlo, Grazia D'Onofrio, Kimberley Ruxton, Stefania Maggi, L. Ferrucci

Research output: Contribution to journalArticle

Abstract

Background & aims: The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. Methods: Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. Results: 1064 patients were included, with 79 (13 in MPI 1–2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19–3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09–3.76), but not in MPI 1–2 class patients (OR = 1.51; 95%CI: 0.44–5.25). The use of propensity score confirmed these findings. Conclusions: ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF.

Original languageEnglish
JournalClinical Nutrition
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Enteral Nutrition
Multicenter Studies
Longitudinal Studies
Mortality
Geriatric Assessment
Propensity Score
Medical Records
Odds Ratio
Confidence Intervals

Keywords

  • Enteral nutrition
  • Hospital
  • Multidimensional prognostic index
  • Prognosis

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine

Cite this

Enteral tube feeding and mortality in hospitalized older patients : A multicenter longitudinal study. / Veronese, Nicola; Cella, Alberto; Cruz-Jentoft, Alfonso J.; Polidori, Maria Cristina; Mattace-Raso, Francesco; Paccalin, Marc; Topinkova, Eva; Greco, Antonio; Mangoni, Arduino A.; Daragjati, J.; Siri, Giacomo; Pilotto, Alberto; Musacchio, Clarissa; Custureri, Romina; Puntoni, Matteo; Simonato, Matteo; Durando, M.; Miret-Corchado, Carmen; Montero-Errasquin, Beatriz; Meyer, Anna; Hoffmann, Dirk; Schulz, Ralf Joachim; Tap, Lisanne; Egberts, Angelique; Bureau, Marie Laure; Brunet, Thomas; Liuu, Evelyne; Michalkova, Helena; Madlova, P.; Sancarlo, Daniele; D'Onofrio, Grazia; Ruxton, Kimberley; Maggi, Stefania; Ferrucci, L.

In: Clinical Nutrition, 01.01.2019.

Research output: Contribution to journalArticle

Veronese, N, Cella, A, Cruz-Jentoft, AJ, Polidori, MC, Mattace-Raso, F, Paccalin, M, Topinkova, E, Greco, A, Mangoni, AA, Daragjati, J, Siri, G, Pilotto, A, Musacchio, C, Custureri, R, Puntoni, M, Simonato, M, Durando, M, Miret-Corchado, C, Montero-Errasquin, B, Meyer, A, Hoffmann, D, Schulz, RJ, Tap, L, Egberts, A, Bureau, ML, Brunet, T, Liuu, E, Michalkova, H, Madlova, P, Sancarlo, D, D'Onofrio, G, Ruxton, K, Maggi, S & Ferrucci, L 2019, 'Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study', Clinical Nutrition. https://doi.org/10.1016/j.clnu.2019.07.011
Veronese, Nicola ; Cella, Alberto ; Cruz-Jentoft, Alfonso J. ; Polidori, Maria Cristina ; Mattace-Raso, Francesco ; Paccalin, Marc ; Topinkova, Eva ; Greco, Antonio ; Mangoni, Arduino A. ; Daragjati, J. ; Siri, Giacomo ; Pilotto, Alberto ; Musacchio, Clarissa ; Custureri, Romina ; Puntoni, Matteo ; Simonato, Matteo ; Durando, M. ; Miret-Corchado, Carmen ; Montero-Errasquin, Beatriz ; Meyer, Anna ; Hoffmann, Dirk ; Schulz, Ralf Joachim ; Tap, Lisanne ; Egberts, Angelique ; Bureau, Marie Laure ; Brunet, Thomas ; Liuu, Evelyne ; Michalkova, Helena ; Madlova, P. ; Sancarlo, Daniele ; D'Onofrio, Grazia ; Ruxton, Kimberley ; Maggi, Stefania ; Ferrucci, L. / Enteral tube feeding and mortality in hospitalized older patients : A multicenter longitudinal study. In: Clinical Nutrition. 2019.
@article{a3f25e7036a842ff879305f3bfe3ac6c,
title = "Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study",
abstract = "Background & aims: The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. Methods: Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. Results: 1064 patients were included, with 79 (13 in MPI 1–2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95{\%} confidence intervals, CI: 1.19–3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95{\%}CI: 1.09–3.76), but not in MPI 1–2 class patients (OR = 1.51; 95{\%}CI: 0.44–5.25). The use of propensity score confirmed these findings. Conclusions: ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF.",
keywords = "Enteral nutrition, Hospital, Multidimensional prognostic index, Prognosis",
author = "Nicola Veronese and Alberto Cella and Cruz-Jentoft, {Alfonso J.} and Polidori, {Maria Cristina} and Francesco Mattace-Raso and Marc Paccalin and Eva Topinkova and Antonio Greco and Mangoni, {Arduino A.} and J. Daragjati and Giacomo Siri and Alberto Pilotto and Clarissa Musacchio and Romina Custureri and Matteo Puntoni and Matteo Simonato and M. Durando and Carmen Miret-Corchado and Beatriz Montero-Errasquin and Anna Meyer and Dirk Hoffmann and Schulz, {Ralf Joachim} and Lisanne Tap and Angelique Egberts and Bureau, {Marie Laure} and Thomas Brunet and Evelyne Liuu and Helena Michalkova and P. Madlova and Daniele Sancarlo and Grazia D'Onofrio and Kimberley Ruxton and Stefania Maggi and L. Ferrucci",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.clnu.2019.07.011",
language = "English",
journal = "Clinical Nutrition",
issn = "0261-5614",
publisher = "Churchill Livingstone",

}

TY - JOUR

T1 - Enteral tube feeding and mortality in hospitalized older patients

T2 - A multicenter longitudinal study

AU - Veronese, Nicola

AU - Cella, Alberto

AU - Cruz-Jentoft, Alfonso J.

AU - Polidori, Maria Cristina

AU - Mattace-Raso, Francesco

AU - Paccalin, Marc

AU - Topinkova, Eva

AU - Greco, Antonio

AU - Mangoni, Arduino A.

AU - Daragjati, J.

AU - Siri, Giacomo

AU - Pilotto, Alberto

AU - Musacchio, Clarissa

AU - Custureri, Romina

AU - Puntoni, Matteo

AU - Simonato, Matteo

AU - Durando, M.

AU - Miret-Corchado, Carmen

AU - Montero-Errasquin, Beatriz

AU - Meyer, Anna

AU - Hoffmann, Dirk

AU - Schulz, Ralf Joachim

AU - Tap, Lisanne

AU - Egberts, Angelique

AU - Bureau, Marie Laure

AU - Brunet, Thomas

AU - Liuu, Evelyne

AU - Michalkova, Helena

AU - Madlova, P.

AU - Sancarlo, Daniele

AU - D'Onofrio, Grazia

AU - Ruxton, Kimberley

AU - Maggi, Stefania

AU - Ferrucci, L.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background & aims: The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. Methods: Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. Results: 1064 patients were included, with 79 (13 in MPI 1–2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19–3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09–3.76), but not in MPI 1–2 class patients (OR = 1.51; 95%CI: 0.44–5.25). The use of propensity score confirmed these findings. Conclusions: ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF.

AB - Background & aims: The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality. Methods: Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information. Results: 1064 patients were included, with 79 (13 in MPI 1–2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19–3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09–3.76), but not in MPI 1–2 class patients (OR = 1.51; 95%CI: 0.44–5.25). The use of propensity score confirmed these findings. Conclusions: ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF.

KW - Enteral nutrition

KW - Hospital

KW - Multidimensional prognostic index

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=85069952743&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069952743&partnerID=8YFLogxK

U2 - 10.1016/j.clnu.2019.07.011

DO - 10.1016/j.clnu.2019.07.011

M3 - Article

AN - SCOPUS:85069952743

JO - Clinical Nutrition

JF - Clinical Nutrition

SN - 0261-5614

ER -