Scored patient-generated Subjective Global Assessment: Length of hospital stay and mortality in cancer patients

ABSTRACT Objective To determine the association of a scored patient-generated Subjective Global Assessment with mortality and length of hospital stay in cancer patients. Methods Cross-sectional study carried out between July and September 2014 using secondary data collection using data from 366 medical records of patients admitted to a hospital recognized as a cancer center of excellence. The present study included patients with hospital stay over than or equal three days and minimum age of 20 years. The patient-generated Subjective Global Assessment scores were calculated and compared with the patients’ clinical and anthropometric characteristics and outcomes (death and long length of stay in hospital). Results Of the 366 patients evaluated, 36.0% were malnourished. The presence of malnutrition, according to the scored patient-generated Subjective Global Assessment, was statistically associated with the presence of metastasis (52.4%). On the other hand, malnutrition, according to the body mass index in adults (55.8%) and in older elderly patients (54.2%), was associated with death (55.0%). The adjusted logistic regression model showed that the following factors were associated with prolonged hospitalization: early nutritional screening, presence of severe malnutrition, radiotherapy and chemotherapy, and surgical procedures. As for mortality, the associated factors were: male reproductive system tumor, presence of metastasis, clinical treatment, prolonged hospitalization, and the presence of some degree of malnutrition. Conclusion The patient-generated Subjective Global Assessment score is an important risk marker of prolonged hospitalization and mortality rates. It is a useful tool capable of circumventing significant biases in the nutritional evaluation of cancer patients.

摘要
目的 明确经评分的患者自评主观全面营养评估（patient-generated Subjective Global Assessment）与癌症患者死亡率及住院时长的相关性。
方法 本研究为横断面研究，于2014年7月至9月开展，采用二次数据收集方式，纳入某被认定为卓越肿瘤中心的医院的366份住院患者病历数据。本研究纳入住院时长≥3天、年龄≥20岁的患者。研究人员计算了患者自评主观全面营养评估评分，并将其与患者的临床及人体测量学特征、结局指标（死亡与住院时长延长）进行对比分析。
结果 在纳入评估的366例患者中，36.0%存在营养不良。经患者自评主观全面营养评估判定的营养不良与肿瘤转移发生率（52.4%）存在统计学关联。另一方面，基于成人体质量指数（55.8%）及高龄老年患者体质量指数（54.2%）判定的营养不良与死亡率（55.0%）相关。经校正的logistic回归模型显示，以下因素与住院时长延长相关：早期营养筛查、重度营养不良、放化疗及外科手术操作。与死亡率相关的因素包括：男性生殖系统肿瘤、肿瘤转移、临床治疗、住院时长延长及不同程度营养不良。
结论 患者自评主观全面营养评估评分是住院时长延长与死亡率的重要风险标志物，可有效规避癌症患者营养评估中的显著偏倚，是一项极具临床应用价值的工具。