Nutritional Risk Among Emergency Department Patients with Diabetes Mellitus or Chronic Kidney Disease: A Single-Center Prospective Observational Comparative Study.
Patients with diabetes mellitus (DM) and chronic kidney disease (CKD) frequently present to emergency departments (EDs) with acute metabolic or renal complications. Nutritional risk may coexist with disease severity in this population, but its relationship with hospital admission remains insufficiently characterized. This study aimed to compare the nutritional status between admitted and discharged ED patients with DM and/or CKD.
This single-center prospective observational comparative study included 101 adult ED patients with documented DM and/or CKD. Nutritional status was assessed during the ED encounter using the Nutritional Risk Screening-2002 (NRS-2002) and Mini Nutritional Assessment (MNA). Clinical, anthropometric, and laboratory variables were compared between admitted and discharged patients. Logistic regression was used to explore factors associated with hospital admission.
Of 101 patients, 51 were admitted, and 50 were discharged. NRS-2002-defined nutritional risk was more frequent among admitted than discharged patients (64.7% vs. 30.0%; risk difference: 34.7 percentage points, 95% CI: 16.4-53.0; p = 0.001). MNA-defined malnutrition was also more frequent among admitted patients (45.1% vs. 12.0%; risk difference for malnutrition alone: 33.1 percentage points, 95% CI: 16.7-49.5), and the overall MNA category distribution differed significantly between groups (p < 0.001). Admitted patients had higher C-reactive protein and urea concentrations and lower lymphocyte counts (p = 0.001 for all), while creatinine showed a borderline between-group difference (p = 0.049). In the exploratory adjusted model, hospital admission was associated with serum urea (OR: 1.018, 95% CI: 1.007-1.029; p = 0.001), CRP (OR: 1.022, 95% CI: 1.008-1.036; p = 0.002), female sex (OR: 0.307, 95% CI: 0.098-0.965; p = 0.043), and MNA-defined malnutrition compared with normal nutritional status (OR: 7.926, 95% CI: 1.482-42.391; p = 0.016), although estimates were limited by the number of admission events.
Among ED patients with DM and/or CKD, nutritional risk was substantially more common in those requiring hospital admission. This association likely reflects confounding by indication and possible reverse causation, as disposition decisions may incorporate frailty, general appearance, functional decline, and clinical vulnerability, which are also partly captured by nutritional screening tools. Nutritional screening should therefore be interpreted as a marker of clinical vulnerability rather than as an isolated determinant of disposition.
This single-center prospective observational comparative study included 101 adult ED patients with documented DM and/or CKD. Nutritional status was assessed during the ED encounter using the Nutritional Risk Screening-2002 (NRS-2002) and Mini Nutritional Assessment (MNA). Clinical, anthropometric, and laboratory variables were compared between admitted and discharged patients. Logistic regression was used to explore factors associated with hospital admission.
Of 101 patients, 51 were admitted, and 50 were discharged. NRS-2002-defined nutritional risk was more frequent among admitted than discharged patients (64.7% vs. 30.0%; risk difference: 34.7 percentage points, 95% CI: 16.4-53.0; p = 0.001). MNA-defined malnutrition was also more frequent among admitted patients (45.1% vs. 12.0%; risk difference for malnutrition alone: 33.1 percentage points, 95% CI: 16.7-49.5), and the overall MNA category distribution differed significantly between groups (p < 0.001). Admitted patients had higher C-reactive protein and urea concentrations and lower lymphocyte counts (p = 0.001 for all), while creatinine showed a borderline between-group difference (p = 0.049). In the exploratory adjusted model, hospital admission was associated with serum urea (OR: 1.018, 95% CI: 1.007-1.029; p = 0.001), CRP (OR: 1.022, 95% CI: 1.008-1.036; p = 0.002), female sex (OR: 0.307, 95% CI: 0.098-0.965; p = 0.043), and MNA-defined malnutrition compared with normal nutritional status (OR: 7.926, 95% CI: 1.482-42.391; p = 0.016), although estimates were limited by the number of admission events.
Among ED patients with DM and/or CKD, nutritional risk was substantially more common in those requiring hospital admission. This association likely reflects confounding by indication and possible reverse causation, as disposition decisions may incorporate frailty, general appearance, functional decline, and clinical vulnerability, which are also partly captured by nutritional screening tools. Nutritional screening should therefore be interpreted as a marker of clinical vulnerability rather than as an isolated determinant of disposition.
Authors
Ayten Ayten, Ünal Ünal, Pruc Pruc, Niewiadomska Niewiadomska, Szarpak Szarpak
View on Pubmed