Predicting Prognosis: Declining Nutritional Status (Reading & Sharing)

A decline in a patient’s nutritional status is another key indicator of poor prognosis. This is best expressed as an unintentional weight loss of 10 percent of normal body weight over a period of about 6 months, with the loss of weight usually due to the patient’s life-limiting condition.

• Reversible cause of weight loss, such as depression and metabolic disturbances (diabetes, thyroid disease), should be excluded prior to assuming that the weight loss is due to the terminal illness and a true indicator of the patient’s prognosis.
• However, terminally ill patients may still have reversible cause of weight loss. Thus, for terminally ill patients with reversible cause of weight loss, weight loss will be less helpful in determining prognosis.

Body mass index (BMI) is another useful way to evaluate a patient’s nutritional status near the end of life. Some studies demonstrated that BMI values less than 22 correlated with dependence in the activities of daily living (ADLs) as well as with increased mortality rates in elderly patients. It has also been reported that in seriously ill hospitalized patients, those with BMI values less than 20 had the highest risk of mortality in the 6 months following hospitalization.