To investigate the independent and combined predictive value of nutritional risk and iron deficiency for 28-day mortality in older ED patients.
Approach:
Study Design: A prospective cohort study enrolling 443 patients aged ≥ 60 years from the ED resuscitation room.
Patient Stratification: Patients were categorized into four groups based on modified Nutrition Risk in the Critically Ill (mNUTRIC) score and iron deficiency status.
Statistical Analysis: Multivariate Cox regression and mediation analysis were used to identify risk factors and explore mechanistic pathways.
Key Findings:
The overall 28-day mortality rate was 22.8%.
Patients with high nutritional risk and iron deficiency (G4) had a mortality rate of 42.7%.
The risk of mortality in G4 was 4.9 times greater than in G1 (adjusted HR = 4.901, p < 0.001).
Hemoglobin was a strong independent protective factor (HR = 0.976, p < 0.001).
Excess mortality risk in G4 was concentrated in patients with concurrent anemia (HR = 6.224).
Interpretation:
The coexistence of high nutritional risk and iron deficiency significantly increases mortality risk in older ED patients.
Limitations:
The study was conducted in a single center, which may limit generalizability.
Exclusion criteria may have omitted patients with significant comorbidities affecting nutritional status.
Conclusion:
High nutritional risk and iron deficiency have a synergistic effect on mortality in older ED patients.
