array:25 [
  "pii" => "S2173511514001110"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2014.01.009"
  "estado" => "S300"
  "fechaPublicacion" => "2014-11-01"
  "aid" => "208"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Rev Port Pneumol. 2014;20:293-8"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1606
    "formatos" => array:3 [
      "EPUB" => 269
      "HTML" => 794
      "PDF" => 543
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S0873215914000075"
      "issn" => "08732159"
      "doi" => "10.1016/j.rppneu.2014.01.004"
      "estado" => "S300"
      "fechaPublicacion" => "2014-11-01"
      "aid" => "208"
      "copyright" => "Sociedade Portuguesa de Pneumologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Rev Port Pneumol. 2014;20:293-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 5948
        "formatos" => array:3 [
          "EPUB" => 256
          "HTML" => 4768
          "PDF" => 924
        ]
      ]
      "en" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
        "titulo" => "Nutritional Screening of Pulmonology Department Inpatients"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "tieneResumen" => array:2 [
          0 => "en"
          1 => "pt"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "293"
            "paginaFinal" => "298"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Rastreio nutricional dos doentes internados no departamento de pneumologia"
          ]
        ]
        "contieneResumen" => array:2 [
          "en" => true
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Isabel Maia, S&#243;nia Xar&#225;, Isabel Dias, B&#225;rbara Parente, Teresa F&#46; Amaral"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "Isabel"
                "apellidos" => "Maia"
              ]
              1 => array:2 [
                "nombre" => "S&#243;nia"
                "apellidos" => "Xar&#225;"
              ]
              2 => array:2 [
                "nombre" => "Isabel"
                "apellidos" => "Dias"
              ]
              3 => array:2 [
                "nombre" => "B&#225;rbara"
                "apellidos" => "Parente"
              ]
              4 => array:2 [
                "nombre" => "Teresa F&#46;"
                "apellidos" => "Amaral"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173511514001110"
          "doi" => "10.1016/j.rppnen.2014.01.009"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511514001110?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215914000075?idApp=UINPBA00004E"
      "url" => "/08732159/0000002000000006/v2_201509071019/S0873215914000075/v2_201509071019/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511514001079"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2014.03.015"
    "estado" => "S300"
    "fechaPublicacion" => "2014-11-01"
    "aid" => "230"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2014;20:299-304"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1940
      "formatos" => array:3 [
        "EPUB" => 239
        "HTML" => 1071
        "PDF" => 630
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Effect of a Pulmonary Rehabilitation Program on the levels of anxiety and depression and on the quality of life of patients with chronic obstructive pulmonary disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "299"
          "paginaFinal" => "304"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Efeito de um Programa de Reabilita&#231;&#227;o Pulmonar nos n&#237;veis de ansiedade e depress&#227;o e na qualidade de vida de pacientes com doen&#231;a pulmonar obstrutiva cr&#244;nica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C&#46;C&#46; da Costa, C&#46; de Azeredo Lermen, C&#46; Colombo, D&#46;B&#46; Canterle, M&#46;L&#46;L&#46; Machado, A&#46; Kessler, P&#46;J&#46;Z&#46; Teixeira"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "C&#46;C&#46;"
              "apellidos" => "da Costa"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "de Azeredo Lermen"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Colombo"
            ]
            3 => array:2 [
              "nombre" => "D&#46;B&#46;"
              "apellidos" => "Canterle"
            ]
            4 => array:2 [
              "nombre" => "M&#46;L&#46;L&#46;"
              "apellidos" => "Machado"
            ]
            5 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Kessler"
            ]
            6 => array:2 [
              "nombre" => "P&#46;J&#46;Z&#46;"
              "apellidos" => "Teixeira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S087321591400052X"
        "doi" => "10.1016/j.rppneu.2014.03.007"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S087321591400052X?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511514001079?idApp=UINPBA00004E"
    "url" => "/21735115/0000002000000006/v1_201412160104/S2173511514001079/v1_201412160104/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2173511514001134"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2014.09.002"
    "estado" => "S300"
    "fechaPublicacion" => "2014-11-01"
    "aid" => "254"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "edi"
    "cita" => "Rev Port Pneumol. 2014;20:289-92"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2226
      "formatos" => array:3 [
        "EPUB" => 224
        "HTML" => 1470
        "PDF" => 532
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Tobacco control progress in Portugal&#58; The need for advocacy and civil society leadership"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "289"
          "paginaFinal" => "292"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Para o progresso do controlo de tabagismo em Portugal&#58; a necessidade de activismo e lideran&#231;a da sociedade civil"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#46;B&#46; Ravara, N&#46; Miranda, J&#46;M&#46; Calheiros, F&#46; Berteletti, L&#46; Joossens"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "S&#46;B&#46;"
              "apellidos" => "Ravara"
            ]
            1 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Miranda"
            ]
            2 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Calheiros"
            ]
            3 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Berteletti"
            ]
            4 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Joossens"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511514001134?idApp=UINPBA00004E"
    "url" => "/21735115/0000002000000006/v1_201412160104/S2173511514001134/v1_201412160104/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:18 [
      "pii" => "S2173511514001134"
      "issn" => "21735115"
      "doi" => "10.1016/j.rppnen.2014.09.002"
      "estado" => "S300"
      "fechaPublicacion" => "2014-11-01"
      "aid" => "254"
      "copyright" => "Sociedade Portuguesa de Pneumologia"
      "documento" => "simple-article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "edi"
      "cita" => "Rev Port Pneumol. 2014;20:289-92"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2226
        "formatos" => array:3 [
          "EPUB" => 224
          "HTML" => 1470
          "PDF" => 532
        ]
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "Tobacco control progress in Portugal&#58; The need for advocacy and civil society leadership"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "289"
            "paginaFinal" => "292"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Para o progresso do controlo de tabagismo em Portugal&#58; a necessidade de activismo e lideran&#231;a da sociedade civil"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "S&#46;B&#46; Ravara, N&#46; Miranda, J&#46;M&#46; Calheiros, F&#46; Berteletti, L&#46; Joossens"
            "autores" => array:5 [
              0 => array:2 [
                "nombre" => "S&#46;B&#46;"
                "apellidos" => "Ravara"
              ]
              1 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Miranda"
              ]
              2 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Calheiros"
              ]
              3 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Berteletti"
              ]
              4 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Joossens"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511514001134?idApp=UINPBA00004E"
      "url" => "/21735115/0000002000000006/v1_201412160104/S2173511514001134/v1_201412160104/en/main.assets"
    ]
  ]
  "en" => array:18 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Nutritional Screening of Pulmonology Department Inpatients"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "293"
        "paginaFinal" => "298"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Isabel Maia, S&#243;nia Xar&#225;, Isabel Dias, B&#225;rbara Parente, Teresa F&#46; Amaral"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Isabel"
            "apellidos" => "Maia"
            "email" => array:1 [
              0 => "isabelmoreiramaia&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "S&#243;nia"
            "apellidos" => "Xar&#225;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Isabel"
            "apellidos" => "Dias"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "B&#225;rbara"
            "apellidos" => "Parente"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Teresa F&#46;"
            "apellidos" => "Amaral"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servi&#231;o de Nutri&#231;&#227;o e Diet&#233;tica&#44; Centro Hospitalar de Vila Nova de Gaia&#47;Espinho&#44; Gaia&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0010"
          ]
          1 => array:3 [
            "entidad" => "Servi&#231;o de Pneumologia&#44; Centro Hospitalar de Vila Nova de Gaia&#47;Espinho&#44; Gaia&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0015"
          ]
          2 => array:3 [
            "entidad" => "Faculdade de Ci&#234;ncias da Nutri&#231;&#227;o e Alimenta&#231;&#227;o da Universidade do Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Rastreio nutricional dos doentes internados no departamento de pneumologia"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">It is increasingly widely recognized that hospitalized patients are undernourished and that circa 30&#37; of patients are at nutritional risk on admission to hospital&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Chronic Obstructive Pulmonary Disease &#40;COPD&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> lung cancer<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> and tuberculosis<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> are pathologies that tend to be associated with undernutrition&#46; Although the frequency of undernutrition risk in these pathologies has been studied&#44; the data on the nutritional status of patients admitted to Pulmonology departments in very limited&#46; A multicenter study conducted recently by Fang <span class="elsevierStyleItalic">et al</span>&#46; in China revealed a frequency of 55&#46;9&#37; of undernutrition risk in a Pulmonology unit&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> which justified the need to clarify whether the extent of this problem is confirmed in Portugal&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Some of the factors that increase undernutrition risk have already been mentioned&#44; namely female gender and advanced age&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;8</span></a> The presence of the disease is critical since it is associated with increased risk of infection&#44; organ dysfunction and pharmacological therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;8&#44;12&#44;13</span></a> In the past not enough attention was given to the importance of evaluating and monitoring parameters related to nutritional status&#44; however the need to conduct undernutrition screening has now been widely recognized&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Screening for undernutrition is justified by the fact that undernutrition is associated with adverse consequences for health as it increases predisposition to disease and inhibits recovery&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> It has been reported that undernourished patients stay in hospital approximately 1&#46;5-1&#46;7 times longer than normal weight patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;14&#44;15</span></a> Undernutrition also increases the risk of infections and multiorgan dysfunction&#44; the pressure on health care facilities and mortality&#44; all of which have strong economic consequences&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;13&#44;16&#8211;18</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; the association between undernutrition risk and hospital admission pathology&#44; time of admission and clinical outcomes has not been quantified for pulmonology patients&#44; hence the need to conduct this research to improve our understanding of the extent of the problem and to confirm whether the associations already described for other classes of diseases can be confirmed in Pulmonology patients&#46; The present study aims to contribute to the characterization of the risk of undernutrition of patients admitted to Pulmonology units and to quantify the possible associations between undernutrition risk&#44; assessed by the Malnutrition Universal Screening Tool &#40;MUST&#41; and admission pathology&#44; length of hospital stay and discharge destination&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Design and participants</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted a longitudinal study in the Department of Pulmonology at the Hospital Centre of Vila Nova de Gaia&#47;Espinho&#44; Entidade P&#250;blica&#44; which included all the patients&#44; aged 18 and above&#44; who were admitted between February and July 2013&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">This study was approved by the Ethics Committee and the Board of Directors of this Hospital Center and the anonymity of the participants was guaranteed&#46; All information was obtained according to Declaration of Helsinki recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Data Collection</span><p id="par0035" class="elsevierStylePara elsevierViewall">Data on demographics &#40;age and sex&#41;&#44; clinical characteristics&#44; the condition that prompted admission&#44; length of hospital stay &#40;number of days between admission and discharge&#41; and also destination post- hospital &#40;home&#44; transfer to Continuing Care Unit &#40;CCU&#41; or death&#41; were obtained from the clinical files&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The assessment of undernutrition risk was conducted using the MUST in the first 72<span class="elsevierStyleHsp" style=""></span>hours after admission&#46; This tool is based on three criteria&#44; namely Body Mass Index &#40;BMI&#41;&#44; unintentional weight loss over the previous three to six months and significant decrease in food intake associated with acute illness for a period of more than five days&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;20</span></a> This tool is validated for use in hospitals&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;16</span></a> Stratton <span class="elsevierStyleItalic">et al&#46;</span> compared different screening and nutritional evaluation tools with MUST&#44; including the Mini Nutritional Assessment&#44; the Patient - Generated Subjective Global Assessment&#44; the Malnutrition Screening Tool&#44; the Malnutrition Risk Score and Nutrition Risk Score in hospital&#44; and showed that MUST compared to the other tools reviewed had reasonable to excellent validity&#44; as well as being quick and easy to use and it also demonstrated excellent reproducibility among different users&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Anthropometric evaluation was performed according to standard procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Height and weight were measured using Seca&#174; scale with an incorporated stadiometer&#46; Where it was not possible to obtain these measurements&#44; reported weight and height were used to estimate the alternative BMI&#44; and also mid upper arm circumference &#40;MUAC&#41; following the criteria recommended by MUST&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> To calculate weight loss percentage over the last three to six months the usual weight recorded in the medical record was considered&#46; If not available&#44; the weight reported by the patient was used&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> All information was collected by the same interviewer &#40;IM&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The final score of the MUST was obtained by adding the scores for each of the three parameters evaluated&#44; ranking undernutrition risk as low&#44; moderate or high&#44; if the score is 0&#44; 1&#44; or higher than or equal to 2&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;20</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Data Analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Frequencies&#44; means and their standard deviation variables were calculated&#46; For comparative analysis of length of hospital stay by MUST classification&#44; patients who died during hospitalization and those who were discharged on request were excluded&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Continuous variables were compared using the Kruskal-Wallis test&#46; Chi&#8211;square test was used to compare proportions between categorical variables&#46; To estimate the magnitude of association between the studied parameters and undernutrition risk&#44; odds ratio &#40;OR&#41; and their respective 95&#37; confidence intervals were calculated and further adjusted for sex and age using unconditional logistic regression&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Statistical analysis was carried out using the Statistical Package for Social Sciences &#40;version 20&#46;0&#41;&#46; The adopted significance level was 5&#37;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">This sample was composed of 323 patients &#40;220 male and 103 female&#41;&#44; with 18&#46;3&#37; showing high risk of undernutrition and 15&#46;5&#37; moderate risk&#46; The pathology that most frequently led to hospitalization in patients at moderate and high undernutrition risk was&#44; respectively&#44; COPD &#40;22&#37; and 27&#46;1&#37;&#41; and lung cancer &#40;26&#37; and 23&#46;7&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The patients at high risk of undernutrition were those who had a weight loss of often more than 10&#37; &#40;p &#60; 0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; There were no statistically significant differences in hospital length of stay according to undernutrition risk classes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;765&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Undernutrition risk and hospital discharge destination were not independent &#40;p&#60;0&#46;001&#41;&#46; A higher proportion of patients with low risk of undernutrition were found to be discharged home&#44; while the proportion of deaths was higher in patients with a high risk of undernutrition &#40;25&#46;4&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Stratifying patients by BMI categorization&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> revealed that 66&#46;7&#37; of patients with high risk of undernutrition had low weight &#40;p&#60;0&#46;001&#41;&#46; In the remaining classes of undernutrition risk&#44; the majority of patients had normal&#8211;weight &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In multivariate analysis&#44; males showed a higher undernutrition risk compared to females &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;79&#44; 95&#37; CI&#58; 1&#46;06-3&#46;01&#41;&#46; COPD was the pathology associated with a higher risk of undernutrition &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;04&#44; 95&#37; CI&#58; 1&#46;83&#8211;8&#46;90&#41;&#46; It was also observed that pneumonia &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;31&#44; 95&#37; CI&#58; 1&#46;15-4&#46;64&#41; and lung cancer were associated with high undernutrition risk &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;12&#44; 95&#37; CI&#58; 1&#46;01-4&#46;47&#41;&#46; Moreover&#44; patients at moderate&#47;high risk of undernutrition are 2&#46;72 times more likely to die during hospitalization &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;72 95&#37; CI&#58; 1&#46;48-4&#46;97&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The frequency of Pulmonology patients at high &#40;18&#46;3&#37;&#41; and moderate undernutrition risk &#40;15&#46;5&#37;&#41; at the time of hospital admission was shown to be relevant&#59; one in three patients admitted to this unit is at risk of undernutrition&#46; Fang <span class="elsevierStyleItalic">et al&#46;</span> using the Nutritional Risk Screening 2002 reported recently on 440 patients admitted to a Chinese Pulmonology unit who had a higher risk of undernutrition &#40;55&#46;9&#37;&#41; than found in this present study&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Using the same method&#44; Lucchini <span class="elsevierStyleItalic">et al</span>&#46; reported on a sample of 35 patients admitted to an Italian Pulmonology Department of whom 40&#46;0&#37; were at risk of undernutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Previous studies evaluating the frequency of risk of undernutrition using the MUST have been conducted among patients from other medical departments&#46; In one Internal Medical unit&#44; 25&#46;4&#37; of patients showed a high risk of undernutrition&#44; higher than that found in the present sample&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Similarly&#44; 47&#46;5&#37; of surgery patients were at high risk&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> These differences may be explained by the characteristics of the sample and the methodology used&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Diseases such as COPD&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a> lung cancer<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> and pneumonia stood out<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> among the conditions which led to hospitalization of patients at high risk of undernutrition&#46; It has been reported that pneumonia patients have a higher prevalence of weight loss and biochemical changes related to nutritional status such as hypoalbuminemia&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> These changes may explain high frequency of undernutrition in these patients&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">According to the literature&#44; tumours are associated with high rates of undernutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> A study by Zhang <span class="elsevierStyleItalic">et al</span>&#46; conducted in patients hospitalized with a diagnosis of lung cancer&#44; showed that 33&#37; had undernutrition risk&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Although a different undernutrition screening tool &#40;the Mini Nutritional Assessment&#41; was used from the one in the present study&#44; a significant frequency of patients with lung cancer at undernutrition risk &#40;23&#46;7&#37;&#41; was identified&#46; The fact that some patients with lung cancer had previously received nutritional advice&#44; may have contributed to a lower frequency of undernutrition risk than previously reported&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Gupta <span class="elsevierStyleItalic">et al</span>&#46; conducted a study amongst hospitalized patients with COPD which showed that 83&#46;0&#37; were undernourished&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the present study&#44; a high proportion of COPD patients &#40;27&#46;1&#37;&#41; were at a high risk for undernutrition&#46; It is not known if the previous study of the association between the reason for admission and risk of undernutrition was in an environment similar to this study&#44; so comparisons cannot be made&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">When comparing the frequencies of the outcomes of hospitalization according to risks of undernutrition it was found that the majority of patients with low risk were released home and the number of deaths was higher in patients who were at risk of undernutrition &#40;25&#46;4&#37;&#41;&#46; These results are consistent with indications that undernutrition is associated with increased risk of mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Contrary to what has been previously described&#44; it was found that males are more likely to be at medium&#47;high undernutrition risk<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;8</span></a> and no differences were found in length of hospital stay according with undernutrition risk classes&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">This research has some strengths&#59; it is heterogeneous as it is composed of patients with different reasons for hospital admission and covers the full spectrum of diseases treated in a department of pulmonology&#46; The study used MUST as the undernutrition screening tool as it is recommended for this purpose and has been validated for use in hospital&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;16</span></a> The fact that all the data was collected by the same investigator reduces the possibility of inter-observer variations and the possibility of misclassification in undernutrition risk classification&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The limitations of the present study include those inherent to its design&#46; Patients admitted to the department studied may not represent the full spectrum of nutritionally relevant Pulmonology diagnoses and stages&#44; especially those which are seasonal&#44; although a relevant consecutive sample was obtained&#46; Also&#44; the small sample size obtained in some diagnostic groups compromised the statistical analyses and the inference for some types of patients&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">We can conclude that patients in the Pulmonology Department showed a significant rate of undernutrition risk and patients with COPD or lung cancer were those with the highest risk of undernutrition&#46; Patients at undernutrition risk were more likely to die during hospitalization&#46; These results reinforce the need to screen all patients in pulmonology hospital care for undernutrition risk&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Ethical disclosures</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Protection of human and animal subjects</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Confidentiality of data</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Right to privacy and informed consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have obtained the written informed consent of the patients or subjects mentioned in the article&#46; The corresponding author is in possession of this document&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:2 [
          "identificador" => "xres390754"
          "titulo" => "Abstract"
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec368883"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres390755"
          "titulo" => "Resumo"
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec368884"
          "titulo" => "Palavras-chave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Design and participants"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Data Collection"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Data Analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Discussion"
        ]
        8 => array:3 [
          "identificador" => "sec0040"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-11-27"
    "fechaAceptado" => "2014-01-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec368883"
          "palabras" => array:5 [
            0 => "Screening"
            1 => "Undernutrition"
            2 => "Nutritional screening"
            3 => "<span class="elsevierStyleItalic">Malnutrition Universal Screening Tool</span>"
            4 => "<span class="elsevierStyleItalic">Pulmonology</span>"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec368884"
          "palabras" => array:5 [
            0 => "Rastreio"
            1 => "Desnutri&#231;&#227;o"
            2 => "Risco Nutricional"
            3 => "<span class="elsevierStyleItalic">Malnutrition Universal Screening Tool</span>"
            4 => "<span class="elsevierStyleItalic">Pneumologia</span>"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Undernutrition is associated with worse clinical outcomes and so screening is recommended&#46; Given the paucity of information on nutritional status and on the clinical impact of undernutrition in Pulmonology patients who have been hospitalized&#44; it is of the utmost importance that it is studied&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Through a longitudinal study conducted of 323 patients consecutively admitted to a Pulmonology hospital department&#44; undernutrition was screened using the Malnutrition Universal Screening Tool and the association between length of hospital stay&#44; pathology type&#44; discharge destination and undernutrition risk was quantified&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There was found to be a high proportion of patients at risk of undernutrition&#44; with 18&#46;3&#37; at high risk and 15&#46;5&#37; at moderate risk&#46; Patients at risk of undernutrition had a higher risk of dying during hospitalization &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;72&#44; 95&#37; CI&#58; 1&#46;48- 4&#46;97&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">One in three patients admitted to this unit is at risk of undernutrition&#59; chronic obstructive pulmonary disease was the pathology most strongly associated with undernutrition risk&#46; Present data reinforces the need for screening for undernutrition on admission&#46;</p>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A desnutri&#231;&#227;o encontra-se associada a uma evolu&#231;&#227;o cl&#237;nica mais desfavor&#225;vel e&#44; por isso&#44; &#233; recomendado o seu rastreio&#46; Dada a escassez de informa&#231;&#227;o sobre o estado nutricional e sobre o impacto cl&#237;nico da desnutri&#231;&#227;o nos doentes respirat&#243;rios que estiveram hospitalizados&#44; &#233; da maior import&#226;ncia que este seja estudado&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Atrav&#233;s de um estudo longitudinal realizado em 323 doentes&#44; consecutivamente hospitalizados no departamento de pneumologia de um hospital&#44; avaliou-se o risco de desnutri&#231;&#227;o com recurso ao <span class="elsevierStyleItalic">Malnutrition Universal Screening Tool</span> e foi quantificada a associa&#231;&#227;o entre o tempo de perman&#234;ncia no hospital&#44; o tipo de patologia&#44; o destino da alta e o risco de desnutri&#231;&#227;o&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Verificou-se existir uma elevada percentagem de doentes em risco de desnutri&#231;&#227;o&#44; 18&#44;3&#37; com risco elevado e 15&#44;5&#37; com risco moderado&#46; Os doentes em risco de desnutri&#231;&#227;o apresentaram um risco mais elevado de morrerem durante a hospitaliza&#231;&#227;o &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;72&#59; 95&#37; IC&#58; 1&#44;48-4&#44;97&#41;&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Um em cada 3 doentes admitidos nesta unidade est&#225; em risco de desnutri&#231;&#227;o&#59; a doen&#231;a pulmonar obstrutiva cr&#243;nica foi a patologia mais fortemente associada ao risco de desnutri&#231;&#227;o&#46; Os dados actuais refor&#231;am a necessidade de um rastreio para a desnutri&#231;&#227;o&#44; na admiss&#227;o&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">sd&#58; standard deviation&#59; COPD&#58; Chronic Obstructive Pulmonary Disease&#59; CCU&#58; Continuing Care Unit&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Undernutrition Risk &#40;MUST&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Undernutrition risk</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">214 &#40;66&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;15&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age <span class="elsevierStyleItalic">&#40;years&#41; Mean &#40;sd&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;4 &#40;16&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;0 &#40;17&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;8 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">0&#46;233</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;64&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;76&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;76&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">0&#46;087</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;36&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;24&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;23&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pathology</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;23&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;22&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;27&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60 &#40;28&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;18&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lung Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;11&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#40;26&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;23&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asthma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;13&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumothorax&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;6&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Empyema&#47;Lung Abscess&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Bronchiectasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;6&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tuberculosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Others<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;10&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Length of hospital stay</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;days&#41;Median &#40;P25&#59;P75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;8&#59;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#40;8&#59;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;8&#59;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;765&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Discharge destination</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Home&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">189 &#40;88&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;74&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;69&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#60;</span>0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CCU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;11&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;22&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;25&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab602600.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">n &#40;&#37;&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Respiratory Failure &#40;n&#61;10&#41;&#59; Bronchospasm resistant to therapy &#40;n&#61;1&#41;&#44; Pulmonary fibrosis &#40;n&#61;3&#41;&#44; Pulmonary hypertension &#40;n&#61;1&#41;&#44; Sarcoidosis &#40;n&#61;1&#41;&#59; Splenic biopsy &#40;n&#61;1&#41;&#59; Pulmonary hamartoma &#40;n&#61;1&#41;&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Patients who died during hospitalization were excluded &#40;n&#61;51&#41;&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Sample characterization according to the undernutrition risk&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Undernutrition Risk</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">High&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;sd&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;2 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;6 &#40;4&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;0 &#40;2&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;18&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>18&#46;5-24&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;40&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;59&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>25&#46;0-29&#46;9<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62 &#40;33&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;24&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;30&#46;0<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;26&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;13&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">MUAC &#40;cm&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mean &#40;sd&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#46;0 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#46;4 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;5 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;23&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;53&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;82&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;23&#46;5<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;93&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;46&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Weight loss &#40;&#37;&#41;</span><span class="elsevierStyleSup">b</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Without weight loss<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108 &#40;59&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;11&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;5<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;39&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;17&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5-10<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;1&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;71&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;31&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;10<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;45&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab602601.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">n &#40;&#37;&#41;&#46;</p> <p class="elsevierStyleNotepara" id="npar0025"><span class="elsevierStyleSup">b</span> Weight loss percentage was calculated only for 260 patients&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Anthropometric characteristics of the sample according to undernutrition risk&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">COPD&#58; Chronic Obstructive Pulmonary Disease&#59; CCU&#58; Continuing Care Unit&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span>Asthma &#40;n&#61;27&#41;&#59; Pneumothorax &#40;n&#61;16&#41;&#59; Empyema&#47;Lung Abscess &#40;n&#61;13&#41;&#59; Bronchiectasis &#40;n&#61;10&#41;&#59; Tuberculosis &#40;n&#61;9&#41;&#59; Others &#40;n&#61;12&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Crude Odds Ratio &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Adjusted Odds Ratio &#40;95&#37; CI&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;79 &#40;1&#46;07-3&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;79 &#40;1&#46;06-3&#46;01&#41;<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;64&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>65&#46;0-74&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;73 &#40;0&#46;96-3&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;068&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;72 &#40;0&#46;95-3&#46;12&#41;<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;072&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;75&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;20 &#40;0&#46;70-2&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;509&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;22 &#40;0&#46;71-2&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;481&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">BMI &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8804;24&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;25&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15 &#40;0&#46;08-0&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15 &#40;0&#46;08-0&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">MUAC &#40;cm&#41;</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;23&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;23&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;03 &#40;0&#46;01-0&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;25 &#40;6&#46;99-220&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Weight loss &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">e</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5-10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;50 &#40;0&#46;59-3&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;391&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">205&#46;2 &#40;54&#46;3-775&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Pathology</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;07 &#40;0&#46;59-3&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;834&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;04 &#40;1&#46;83-8&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pneumonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;49 &#40;0&#46;25-0&#46;98&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;31 &#40;1&#46;15-4&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Lung Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;13 &#40;1&#46;10-4&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;025&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;12 &#40;1&#46;01-4&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other Pathologies<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Discharge</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Home&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;reference&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CCU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;52 &#40;1&#46;37-4&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;72 &#40;1&#46;48-4&#46;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab602602.png"
              ]
            ]
          ]
          "notaPie" => array:5 [
            0 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Adjusted for sex and age&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0045"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Adjusted for age&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0050"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Adjusted for sex&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0055"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Weight loss percentage was calculated only for 260 patients&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "f"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Not calculated due to the small number in some categories&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Factors associated with the undernutrition risk&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Basics in Clinical Nutrition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Sobotka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:6 [
                        "edicion" => "4<span class="elsevierStyleSup">th</span> ed&#46;"
                        "fecha" => "2011"
                        "paginaInicial" => "47"
                        "paginaFinal" => "48"
                        "editorial" => "Czech Republic"
                        "editorialLocalizacion" => "Gal&#233;n"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ESPEN Guidelines for Nutrition Screening 2002"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Kondrup"
                            1 => "S&#46; Allison"
                            2 => "M&#46; Elia"
                            3 => "B&#46; Vella"
                            4 => "M&#46; Plauth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinical Nutrition"
                        "fecha" => "2002"
                        "volumen" => "22"
                        "paginaInicial" => "415"
                        "paginaFinal" => "421"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12880610"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutritional status recording in hospitalized patient notes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "L&#46; Matos"
                            1 => "M&#46;A&#46; Teixeira"
                            2 => "A&#46; Henriques"
                            3 => "M&#46; Tavares"
                            4 => "L&#46; &#193;lvares"
                            5 => "A&#46; Antunes"
                            6 => "T&#46; Amaral"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta M&#233;dica Portuguesa"
                        "fecha" => "2007"
                        "volumen" => "20"
                        "paginaInicial" => "503"
                        "paginaFinal" => "510"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18331694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutritional status and disease severity in patients with chronic obstructive pulmonary disease &#40;COPD&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "H&#46; Lee"
                            1 => "S&#46; Kim"
                            2 => "Y&#46; LIm"
                            3 => "H&#46; Gwon"
                            4 => "Y&#46; Kim"
                            5 => "J&#46; Ahn"
                            6 => "H&#46; Park"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.archger.2012.12.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Archives of Gerontology and Geriatrics"
                        "fecha" => "2013"
                        "volumen" => "56"
                        "paginaInicial" => "518"
                        "paginaFinal" => "523"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23352455"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subjective global assessment of nutritional status of chronic obstructive pulmonary disease patients on admission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46; Gupta"
                            1 => "S&#46; Kant"
                            2 => "R&#46; Mishra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "The International Journal of Tuberculosis and Lung Disease"
                        "fecha" => "2010"
                        "volumen" => "14"
                        "paginaInicial" => "500"
                        "paginaFinal" => "505"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20202310"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutritional status of chronic obstructive pulmonary disease patients admitted in hospital with acute exacerbation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "B&#46; Gupta"
                            1 => "S&#46; Kant"
                            2 => "R&#46; Mishra"
                            3 => "S&#46; Verma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4021/jocmr2010.03.261e"
                      "Revista" => array:6 [
                        "tituloSerie" => "Journal of Clinical Medicine Research"
                        "fecha" => "2010"
                        "volumen" => "2"
                        "paginaInicial" => "68"
                        "paginaFinal" => "74"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21811522"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of Undernutrition in lung cancer patients&#58; a one-daysurvey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Lemarie"
                            1 => "F&#46; Goldwasser"
                            2 => "M&#46; Michallet"
                            3 => "C&#46; Beauvillain"
                            4 => "X&#46; Hebuterne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Journal of Thoracic Oncology"
                        "fecha" => "2007"
                        "volumen" => "2"
                        "paginaInicial" => "S840"
                        "paginaFinal" => "S841"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "To screen or not to screen for adult Undernutrition&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Elia"
                            1 => "L&#46; Zellipour"
                            2 => "R&#46; Stratton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clnu.2005.03.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinical Nutrition"
                        "fecha" => "2005"
                        "volumen" => "24"
                        "paginaInicial" => "867"
                        "paginaFinal" => "884"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15893857"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutritional screening and assessment in cancer-associated Undernutrition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Davies"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejon.2005.09.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "European Journal of Oncology Nursing"
                        "fecha" => "2005"
                        "volumen" => "9"
                        "paginaInicial" => "S64"
                        "paginaFinal" => "S73"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16437759"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Usefulness of the Undernutrition Screening Tool in patients with pulmonar tuberculosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Miyata"
                            1 => "M&#46; Tanaka"
                            2 => "D&#46; Ihaku"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nut.2011.07.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutrition"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "271"
                        "paginaFinal" => "274"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22055479"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A multicenter assessment of Undernutrition&#44; nutritional risk&#44; and application of nutrition support among hospitalized patients in Guangzhou hospitals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "S&#46; Fang"
                            1 => "J&#46; Long"
                            2 => "R&#46; Tan"
                            3 => "H&#46; Mai"
                            4 => "W&#46; Lu"
                            5 => "F&#46; Yan"
                            6 => "J&#46; Peng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Asia Pac Journal of Clinical Nutrition"
                        "fecha" => "2013"
                        "volumen" => "22"
                        "paginaInicial" => "54"
                        "paginaFinal" => "59"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The German hospital Undernutrition study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:20 [
                            0 => "M&#46; Pirlich"
                            1 => "T&#46; Schutz"
                            2 => "K&#46; Norman"
                            3 => "S&#46; Gastell"
                            4 => "LubkeH"
                            5 => "S&#46; Bischoff"
                            6 => "U&#46; Bolder"
                            7 => "T&#46; Frieling"
                            8 => "H&#46; Guldenzoph"
                            9 => "K&#46; Hahn"
                            10 => "K&#46; Jauch"
                            11 => "K&#46; Schindler"
                            12 => "J&#46; Stein"
                            13 => "D&#46; Volkert"
                            14 => "A&#46; Weimann"
                            15 => "H&#46; Werner"
                            16 => "C&#46; Wolf"
                            17 => "G&#46; Zurcher"
                            18 => "P&#46; Bauer"
                            19 => "H&#46; Lochs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clnu.2006.03.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinical Nutrition"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "563"
                        "paginaFinal" => "572"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16698132"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of a Undernutrition screening tool with subjective assessment in hospitalized patients with cancer &#8211; sensitivity and specificity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Bauer"
                            1 => "S&#46; Capra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Asia Pacific Journal of Clinical Nutrition"
                        "fecha" => "2003"
                        "volumen" => "12"
                        "paginaInicial" => "257"
                        "paginaFinal" => "260"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14505986"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus statement&#58; Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition&#58; characteristics recommended for the identification and documentation of adult undernutrition &#40;undernutrition&#41;"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Academy Undernutrition Work Group&#44; ASPEN Undernutrition Task Force&#44; ASPEN Board of Directors"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; White"
                            1 => "P&#46; Guenter"
                            2 => "G&#46; Jensen"
                            3 => "A&#46; Malone"
                            4 => "M&#46; Schofield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0148607112440285"
                      "Revista" => array:6 [
                        "tituloSerie" => "Journal of Parenteral and Enteral Nutrition"
                        "fecha" => "2012"
                        "volumen" => "36"
                        "paginaInicial" => "275"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22535923"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Todorovic V&#44; Russell C&#44; Elia M&#46; The &#8216;MUST&#8217; explanatory booklet &#8211; A guide to the &#8216;Undernutrition Universal Screening Tool&#8217; for adults&#46; 2003 Dispon&#237;vel em http&#58;&#47;&#47;www&#46;bapen&#46;org&#46;uk&#47;pdfs&#47;must&#47;must&#95;explan&#46;pdf&#46; Access in 20&#47;05&#47;2013&#46;"
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Undernutrition and its impact on costs of hospitalization&#44; length of stay&#44; readmission and 3-year mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Lim"
                            1 => "K&#46; Ong"
                            2 => "Y&#46; Chan"
                            3 => "W&#46; Loke"
                            4 => "M&#46; Ferguson"
                            5 => "L&#46; Daniels"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clnu.2011.11.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinical Nutrition"
                        "fecha" => "2012"
                        "volumen" => "31"
                        "paginaInicial" => "345"
                        "paginaFinal" => "350"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22122869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Undernutrition in hospital outpatients and inpatients&#58; prevalence&#44; concurrent validity and ease of use of the &#8216;Undernutrition universal screening tool &#40;&#8216;MUST&#8217;&#41; for adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:8 [
                            0 => "R&#46; Stratton"
                            1 => "A&#46; Hackston"
                            2 => "D&#46; Longmore"
                            3 => "R&#46; Dixon"
                            4 => "S&#46; Price"
                            5 => "M&#46; Stroud"
                            6 => "C&#46; King"
                            7 => "M&#46; Elia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "British Journal of Nutrition"
                        "fecha" => "2004"
                        "volumen" => "92"
                        "paginaInicial" => "799"
                        "paginaFinal" => "808"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15533269"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The economic impact of disease-related malnutrition at hospital admission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "T&#46;F&#46; Amaral"
                            1 => "L&#46;C&#46; Matos"
                            2 => "M&#46;M&#46; Tavares"
                            3 => "A&#46; Subtil"
                            4 => "R&#46; Martins"
                            5 => "M&#46; Nazar&#233;"
                            6 => "N&#46; Sousa Pereira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.clnu.2007.08.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinical Nutrition"
                        "fecha" => "2007"
                        "volumen" => "26"
                        "paginaInicial" => "778"
                        "paginaFinal" => "784"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17936442"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutrition status of patients during hospitalization&#44; Tehran"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Hossein"
                            1 => "B&#46; Amirkalali"
                            2 => "N&#46; Nayebi"
                            3 => "R&#46; Heshmat"
                            4 => "B&#46; Larijani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Iran Nutrition in Clinical Practice"
                        "fecha" => "2006"
                        "volumen" => "21"
                        "paginaInicial" => "518"
                        "paginaFinal" => "521"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Medical Association&#46; Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects&#59; 1964&#46; Available in&#58; http&#58;&#47;&#47;www&#46;wma&#46;net&#47;en&#47;30publications&#47;10policies&#47;b3&#47;index&#46;html&#46; Access in 04&#47;02&#47;2013&#46;"
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Elia M&#46; The MUST Report &#8211; Nutritional screening of adults&#58; a multidisciplinary responsibility&#46; 2003&#46; Available in&#58; http&#58;&#47;&#47;www&#46;bapen&#46;org&#46;uk&#47;pdfs&#47;must&#47;must&#95;exec&#95;sum&#46;pdf&#46; Access in 13&#47;11&#47;2013&#46;"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutritional Assessment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;D&#46; Lee"
                            1 => "D&#46;C&#46; Nieman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:6 [
                        "edicion" => "6th ed&#46;"
                        "fecha" => "2012"
                        "paginaInicial" => "170"
                        "paginaFinal" => "171"
                        "editorial" => "Boston"
                        "editorialLocalizacion" => "McGraw-Hill"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health&#46; &#8220;Global Database on body mass index&#8221;&#59; 2012&#46; Available in http&#58;&#47;&#47;apps&#46;who&#46;int&#47;bmi&#47;index&#46;jsp&#46; Access in&#58; 13&#47;11&#47;2013&#46;"
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An Italian investigation on nutritional risk at hospital admission&#58; The PIMAI &#40;Project&#58; Iatrogenic Undernutrition in Italy&#41; study&#46; e-SPEN"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "L&#46; Lucchin"
                            1 => "A&#46; D&#8217;Amicis"
                            2 => "M&#46; Gentile"
                            3 => "N&#46; Battistini"
                            4 => "M&#46; Fusco"
                            5 => "A&#46; Palmo"
                            6 => "M&#46; Muscariotoli"
                            7 => "F&#46; Contaldo"
                            8 => "E&#46; Cereda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Journal of Clinical Nutrition and Metabolism"
                        "fecha" => "2009"
                        "volumen" => "4"
                        "paginaInicial" => "1"
                        "paginaFinal" => "4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proactive screening in Israel identifies alarming prevalence of Undernutrition among hospitalized patients &#8211; action is needed"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Koifman"
                            1 => "T&#46; Mashiach"
                            2 => "I&#46; Papier"
                            3 => "A&#46; Karban"
                            4 => "R&#46; Eliakim"
                            5 => "I&#46; Chermesh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.nut.2011.07.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutrition"
                        "fecha" => "2012"
                        "volumen" => "28"
                        "paginaInicial" => "515"
                        "paginaFinal" => "519"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22169118"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of in-hospital mortality of order patients admitted for community-acquired pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:9 [
                            0 => "C&#46; Pernil"
                            1 => "C&#46; Silveira"
                            2 => "T&#46; Marcelino"
                            3 => "C&#46; Teixeira"
                            4 => "C&#46; Gil"
                            5 => "J&#46; Maia"
                            6 => "H&#46; Ma"
                            7 => "W&#46; Tang"
                            8 => "J&#46; Woo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ageing/afr087"
                      "Revista" => array:6 [
                        "tituloSerie" => "Age and Ageing"
                        "fecha" => "2011"
                        "volumen" => "40"
                        "paginaInicial" => "736"
                        "paginaFinal" => "741"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21771744"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessing the nutritional status of elderly Chinese lung cancer patients using the Mini-Nutritional Assessment &#40;MNA&#174;&#41; tool"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:10 [
                            0 => "L&#46; Zhang"
                            1 => "Y&#46; Su"
                            2 => "C&#46; Wang"
                            3 => "Y&#46; Sha"
                            4 => "H&#46; Zhu"
                            5 => "S&#46; Xie"
                            6 => "S&#46; Kwauk"
                            7 => "J&#46; Zhang"
                            8 => "Y&#46; Lin"
                            9 => "C&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/CIA.S41941"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clinical Interventions in Aging"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "287"
                        "paginaFinal" => "291"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23487488"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000002000000006/v1_201412160104/S2173511514001110/v1_201412160104/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9710"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002000000006/v1_201412160104/S2173511514001110/v1_201412160104/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511514001110?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 20. Issue 6.
Pages 293-298 (November - December 2014)
Share
Share
Download PDF
More article options
Visits
1051
Vol. 20. Issue 6.
Pages 293-298 (November - December 2014)
Original article
Full text access
Nutritional Screening of Pulmonology Department Inpatients
Rastreio nutricional dos doentes internados no departamento de pneumologia
Visits
1051
Isabel Maiaa,
Corresponding author
isabelmoreiramaia@gmail.com

Corresponding author.
, Sónia Xaráa, Isabel Diasa, Bárbara Parenteb, Teresa F. Amaralc
a Serviço de Nutrição e Dietética, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
b Serviço de Pneumologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Gaia, Portugal
c Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
Related content
Rev Port Pneumol. 2014;20:289-9210.1016/j.rppnen.2014.09.002
S.B. Ravara, N. Miranda, J.M. Calheiros, F. Berteletti, L. Joossens
This item has received
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Tables (3)
Table 1. Sample characterization according to the undernutrition risk.
Table 2. Anthropometric characteristics of the sample according to undernutrition risk.
Table 3. Factors associated with the undernutrition risk.
Show moreShow less
Abstract

Undernutrition is associated with worse clinical outcomes and so screening is recommended. Given the paucity of information on nutritional status and on the clinical impact of undernutrition in Pulmonology patients who have been hospitalized, it is of the utmost importance that it is studied.

Through a longitudinal study conducted of 323 patients consecutively admitted to a Pulmonology hospital department, undernutrition was screened using the Malnutrition Universal Screening Tool and the association between length of hospital stay, pathology type, discharge destination and undernutrition risk was quantified.

There was found to be a high proportion of patients at risk of undernutrition, with 18.3% at high risk and 15.5% at moderate risk. Patients at risk of undernutrition had a higher risk of dying during hospitalization (OR=2.72, 95% CI: 1.48- 4.97).

One in three patients admitted to this unit is at risk of undernutrition; chronic obstructive pulmonary disease was the pathology most strongly associated with undernutrition risk. Present data reinforces the need for screening for undernutrition on admission.

Keywords:
Screening
Undernutrition
Nutritional screening
Malnutrition Universal Screening Tool
Pulmonology
Resumo

A desnutrição encontra-se associada a uma evolução clínica mais desfavorável e, por isso, é recomendado o seu rastreio. Dada a escassez de informação sobre o estado nutricional e sobre o impacto clínico da desnutrição nos doentes respiratórios que estiveram hospitalizados, é da maior importância que este seja estudado.

Através de um estudo longitudinal realizado em 323 doentes, consecutivamente hospitalizados no departamento de pneumologia de um hospital, avaliou-se o risco de desnutrição com recurso ao Malnutrition Universal Screening Tool e foi quantificada a associação entre o tempo de permanência no hospital, o tipo de patologia, o destino da alta e o risco de desnutrição.

Verificou-se existir uma elevada percentagem de doentes em risco de desnutrição, 18,3% com risco elevado e 15,5% com risco moderado. Os doentes em risco de desnutrição apresentaram um risco mais elevado de morrerem durante a hospitalização (OR=2,72; 95% IC: 1,48-4,97).

Um em cada 3 doentes admitidos nesta unidade está em risco de desnutrição; a doença pulmonar obstrutiva crónica foi a patologia mais fortemente associada ao risco de desnutrição. Os dados actuais reforçam a necessidade de um rastreio para a desnutrição, na admissão.

Palavras-chave:
Rastreio
Desnutrição
Risco Nutricional
Malnutrition Universal Screening Tool
Pneumologia
Full Text
Introduction

It is increasingly widely recognized that hospitalized patients are undernourished and that circa 30% of patients are at nutritional risk on admission to hospital.1–3 Chronic Obstructive Pulmonary Disease (COPD),4–6 lung cancer7,8 and tuberculosis9 are pathologies that tend to be associated with undernutrition. Although the frequency of undernutrition risk in these pathologies has been studied, the data on the nutritional status of patients admitted to Pulmonology departments in very limited. A multicenter study conducted recently by Fang et al. in China revealed a frequency of 55.9% of undernutrition risk in a Pulmonology unit,10 which justified the need to clarify whether the extent of this problem is confirmed in Portugal.

Some of the factors that increase undernutrition risk have already been mentioned, namely female gender and advanced age.11,8 The presence of the disease is critical since it is associated with increased risk of infection, organ dysfunction and pharmacological therapy.3,8,12,13 In the past not enough attention was given to the importance of evaluating and monitoring parameters related to nutritional status, however the need to conduct undernutrition screening has now been widely recognized.11,8

Screening for undernutrition is justified by the fact that undernutrition is associated with adverse consequences for health as it increases predisposition to disease and inhibits recovery.11 It has been reported that undernourished patients stay in hospital approximately 1.5-1.7 times longer than normal weight patients.10,14,15 Undernutrition also increases the risk of infections and multiorgan dysfunction, the pressure on health care facilities and mortality, all of which have strong economic consequences.3,13,16–18

To the best of our knowledge, the association between undernutrition risk and hospital admission pathology, time of admission and clinical outcomes has not been quantified for pulmonology patients, hence the need to conduct this research to improve our understanding of the extent of the problem and to confirm whether the associations already described for other classes of diseases can be confirmed in Pulmonology patients. The present study aims to contribute to the characterization of the risk of undernutrition of patients admitted to Pulmonology units and to quantify the possible associations between undernutrition risk, assessed by the Malnutrition Universal Screening Tool (MUST) and admission pathology, length of hospital stay and discharge destination.

MethodsDesign and participants

We conducted a longitudinal study in the Department of Pulmonology at the Hospital Centre of Vila Nova de Gaia/Espinho, Entidade Pública, which included all the patients, aged 18 and above, who were admitted between February and July 2013.

This study was approved by the Ethics Committee and the Board of Directors of this Hospital Center and the anonymity of the participants was guaranteed. All information was obtained according to Declaration of Helsinki recommendations.19

Data Collection

Data on demographics (age and sex), clinical characteristics, the condition that prompted admission, length of hospital stay (number of days between admission and discharge) and also destination post- hospital (home, transfer to Continuing Care Unit (CCU) or death) were obtained from the clinical files.

The assessment of undernutrition risk was conducted using the MUST in the first 72hours after admission. This tool is based on three criteria, namely Body Mass Index (BMI), unintentional weight loss over the previous three to six months and significant decrease in food intake associated with acute illness for a period of more than five days.14,20 This tool is validated for use in hospitals,14,16 Stratton et al. compared different screening and nutritional evaluation tools with MUST, including the Mini Nutritional Assessment, the Patient - Generated Subjective Global Assessment, the Malnutrition Screening Tool, the Malnutrition Risk Score and Nutrition Risk Score in hospital, and showed that MUST compared to the other tools reviewed had reasonable to excellent validity, as well as being quick and easy to use and it also demonstrated excellent reproducibility among different users.16

Anthropometric evaluation was performed according to standard procedures.21 Height and weight were measured using Seca® scale with an incorporated stadiometer. Where it was not possible to obtain these measurements, reported weight and height were used to estimate the alternative BMI, and also mid upper arm circumference (MUAC) following the criteria recommended by MUST.14 To calculate weight loss percentage over the last three to six months the usual weight recorded in the medical record was considered. If not available, the weight reported by the patient was used.14 All information was collected by the same interviewer (IM).

The final score of the MUST was obtained by adding the scores for each of the three parameters evaluated, ranking undernutrition risk as low, moderate or high, if the score is 0, 1, or higher than or equal to 2, respectively.14,20

Data Analysis

Frequencies, means and their standard deviation variables were calculated. For comparative analysis of length of hospital stay by MUST classification, patients who died during hospitalization and those who were discharged on request were excluded.

Continuous variables were compared using the Kruskal-Wallis test. Chi–square test was used to compare proportions between categorical variables. To estimate the magnitude of association between the studied parameters and undernutrition risk, odds ratio (OR) and their respective 95% confidence intervals were calculated and further adjusted for sex and age using unconditional logistic regression.

Statistical analysis was carried out using the Statistical Package for Social Sciences (version 20.0). The adopted significance level was 5%.

Results

This sample was composed of 323 patients (220 male and 103 female), with 18.3% showing high risk of undernutrition and 15.5% moderate risk. The pathology that most frequently led to hospitalization in patients at moderate and high undernutrition risk was, respectively, COPD (22% and 27.1%) and lung cancer (26% and 23.7%) (Table 1). The patients at high risk of undernutrition were those who had a weight loss of often more than 10% (p < 0.001) (Table 2). There were no statistically significant differences in hospital length of stay according to undernutrition risk classes (p=0.765).

Table 1.

Sample characterization according to the undernutrition risk.

  Undernutrition Risk (MUST)
  Low  Moderate  High  p 
Undernutrition riska  214 (66.2)  50 (15.5)  59 (18.3) 
Age (years) Mean (sd)  63.4 (16.2)  67.0 (17.2)  63.8 (15.4)  0.233 
Sexa
Male  137 (64.0)  38 (76.0)  45 (76.3)  0.087 
Female  77 (36.0)  12 (24.0)  14 (23.7)   
Pathologya        <0.001 
COPD  50 (23.4)  11 (22.0)  16 (27.1)   
Pneumonia  60 (28.0)  4 (8.0)  11 (18.6)   
Lung Cancer  25 (11.7)  13(26.0)  14 (23.7)   
Asthma  29 (13.6)  2 (4.0)  4 (6.8)   
Pneumothorax  13 (6.1)  4 (8.0)  3 (5.1)   
Empyema/Lung Abscess  12 (5.6)  5 (10.0)  2 (3.4)   
Bronchiectasis  8 (3.7)  4 (8.0)  4 (6.8)   
Tuberculosis  6 (2.8)  2 (4.0)  3 (5.1)   
Othersb  11 (5.1)  5 (10.0)  2 (3.4)   
Length of hospital stayc
(days)Median (P25;P75)  10 (8;16)  11(8;18)  12 (8;19)  0.765 
Discharge destinationa
Home  189 (88.3)  37 (74.0)  41 (69.5)  <0.001 
CCU  0 (0)  2 (4.0)  3 (5.1)   
Death  25 (11.7)  11 (22.0)  15 (25.4)   

sd: standard deviation; COPD: Chronic Obstructive Pulmonary Disease; CCU: Continuing Care Unit.

a

n (%).

b

Respiratory Failure (n=10); Bronchospasm resistant to therapy (n=1), Pulmonary fibrosis (n=3), Pulmonary hypertension (n=1), Sarcoidosis (n=1); Splenic biopsy (n=1); Pulmonary hamartoma (n=1).

c

Patients who died during hospitalization were excluded (n=51).

Table 2.

Anthropometric characteristics of the sample according to undernutrition risk.

  Undernutrition Risk
  Low  Moderate  High  p 
BMI (kg/m2)        <0.001 
Mean (sd)  27.2 (5.1)  24.6 (4.5)  18.0 (2.5)   
<18.5a  0 (0.0)  1 (2.7)  28 (66.7)   
18.5-24.9a  74 (40.2)  22 (59.5)  14 (33.3)   
25.0-29.9a  62 (33.7)  9 (24.3)  0 (0.0)   
≥30.0a  48 (26.1)  5 (13.5)  0 (0.0)   
MUAC (cm)        <0.001 
Mean (sd)  26.0 (3.1)  23.4 (2.1)  21.5 (3.2)   
<23.5a  2 (6.7)  7 (53.8)  14 (82.4)   
>23.5a  28 (93.3)  6 (46.2)  3 (17.6)   
Weight loss (%)b
Without weight lossa  108 (59.0)  4 (11.4)  6 (14.3)  <0.001 
<5a  72 (39.3)  6 (17.1)  4 (9.5)   
5-10a  3 (1.6)  25 (71.4)  13 (31.0)   
>10a  0 (0.0)  0 (0.0)  19 (45.2)   
a

n (%).

b Weight loss percentage was calculated only for 260 patients.

Undernutrition risk and hospital discharge destination were not independent (p<0.001). A higher proportion of patients with low risk of undernutrition were found to be discharged home, while the proportion of deaths was higher in patients with a high risk of undernutrition (25.4%) (Table 1). Stratifying patients by BMI categorization,22 revealed that 66.7% of patients with high risk of undernutrition had low weight (p<0.001). In the remaining classes of undernutrition risk, the majority of patients had normal–weight (Table 2).

In multivariate analysis, males showed a higher undernutrition risk compared to females (OR=1.79, 95% CI: 1.06-3.01). COPD was the pathology associated with a higher risk of undernutrition (OR=4.04, 95% CI: 1.83–8.90). It was also observed that pneumonia (OR=2.31, 95% CI: 1.15-4.64) and lung cancer were associated with high undernutrition risk (OR=2.12, 95% CI: 1.01-4.47). Moreover, patients at moderate/high risk of undernutrition are 2.72 times more likely to die during hospitalization (OR=2.72 95% CI: 1.48-4.97) (Table 3).

Table 3.

Factors associated with the undernutrition risk.

  Crude Odds Ratio (95% CI)  Adjusted Odds Ratio (95% CI)b 
Sex
Female  1 (reference)    1 (reference)   
Male  1.79 (1.07-3.02)  0.018  1.79 (1.06-3.01)c  0.029 
Age
≤64.9  1 (reference)    1 (reference)   
65.0-74.9  1.73 (0.96-3.11)  0.068  1.72 (0.95-3.12)d  0.072 
≥75.0  1.20 (0.70-2.05)  0.509  1.22 (0.71-2.90)  0.481 
BMI (kg/m2)
≤24.9  1(reference)    1(reference)   
≥25.0  0.15 (0.08-0.28)  <0.001  0.15 (0.08-0.30)  <0.001 
MUAC (cm)
<23.5  1 (reference)    1(reference)   
>23.5  0.03 (0.01-0.16)  <0.001  39.25 (6.99-220.38)  <0.001 
Weight loss (%)e
<5  1 (reference)    f   
5-10  1.50 (0.59-3.79)  0.391     
>10  205.2 (54.3-775.5)  <0.001     
Pathology
COPD  1.07 (0.59-3.79)  0.834  4.04 (1.83-8.90)  0.001 
Pneumonia  0.49 (0.25-0.98)  0.042  2.31 (1.15-4.64)  0.019 
Lung Cancer  2.13 (1.10-4.14)  0.025  2.12 (1.01-4.47)  0.048 
Other Pathologiesb  1 (reference)    1 (reference)   
Discharge
Home  1 (reference)    1 (reference)   
CCU  0.003  0.001 
Death  2.52 (1.37-4.63)    2.72 (1.48-4.97)   

COPD: Chronic Obstructive Pulmonary Disease; CCU: Continuing Care Unit.

aAsthma (n=27); Pneumothorax (n=16); Empyema/Lung Abscess (n=13); Bronchiectasis (n=10); Tuberculosis (n=9); Others (n=12).

b

Adjusted for sex and age.

c

Adjusted for age.

d

Adjusted for sex.

e

Weight loss percentage was calculated only for 260 patients.

f

Not calculated due to the small number in some categories.

Discussion

The frequency of Pulmonology patients at high (18.3%) and moderate undernutrition risk (15.5%) at the time of hospital admission was shown to be relevant; one in three patients admitted to this unit is at risk of undernutrition. Fang et al. using the Nutritional Risk Screening 2002 reported recently on 440 patients admitted to a Chinese Pulmonology unit who had a higher risk of undernutrition (55.9%) than found in this present study.10 Using the same method, Lucchini et al. reported on a sample of 35 patients admitted to an Italian Pulmonology Department of whom 40.0% were at risk of undernutrition.23

Previous studies evaluating the frequency of risk of undernutrition using the MUST have been conducted among patients from other medical departments. In one Internal Medical unit, 25.4% of patients showed a high risk of undernutrition, higher than that found in the present sample.24 Similarly, 47.5% of surgery patients were at high risk.25 These differences may be explained by the characteristics of the sample and the methodology used.

Diseases such as COPD,4–6 lung cancer7,8 and pneumonia stood out26 among the conditions which led to hospitalization of patients at high risk of undernutrition. It has been reported that pneumonia patients have a higher prevalence of weight loss and biochemical changes related to nutritional status such as hypoalbuminemia.26 These changes may explain high frequency of undernutrition in these patients.

According to the literature, tumours are associated with high rates of undernutrition.8 A study by Zhang et al. conducted in patients hospitalized with a diagnosis of lung cancer, showed that 33% had undernutrition risk.27 Although a different undernutrition screening tool (the Mini Nutritional Assessment) was used from the one in the present study, a significant frequency of patients with lung cancer at undernutrition risk (23.7%) was identified. The fact that some patients with lung cancer had previously received nutritional advice, may have contributed to a lower frequency of undernutrition risk than previously reported.

Gupta et al. conducted a study amongst hospitalized patients with COPD which showed that 83.0% were undernourished.5 In the present study, a high proportion of COPD patients (27.1%) were at a high risk for undernutrition. It is not known if the previous study of the association between the reason for admission and risk of undernutrition was in an environment similar to this study, so comparisons cannot be made.

When comparing the frequencies of the outcomes of hospitalization according to risks of undernutrition it was found that the majority of patients with low risk were released home and the number of deaths was higher in patients who were at risk of undernutrition (25.4%). These results are consistent with indications that undernutrition is associated with increased risk of mortality.26

Contrary to what has been previously described, it was found that males are more likely to be at medium/high undernutrition risk11,8 and no differences were found in length of hospital stay according with undernutrition risk classes.14,15

This research has some strengths; it is heterogeneous as it is composed of patients with different reasons for hospital admission and covers the full spectrum of diseases treated in a department of pulmonology. The study used MUST as the undernutrition screening tool as it is recommended for this purpose and has been validated for use in hospital.14,16 The fact that all the data was collected by the same investigator reduces the possibility of inter-observer variations and the possibility of misclassification in undernutrition risk classification.

The limitations of the present study include those inherent to its design. Patients admitted to the department studied may not represent the full spectrum of nutritionally relevant Pulmonology diagnoses and stages, especially those which are seasonal, although a relevant consecutive sample was obtained. Also, the small sample size obtained in some diagnostic groups compromised the statistical analyses and the inference for some types of patients.

We can conclude that patients in the Pulmonology Department showed a significant rate of undernutrition risk and patients with COPD or lung cancer were those with the highest risk of undernutrition. Patients at undernutrition risk were more likely to die during hospitalization. These results reinforce the need to screen all patients in pulmonology hospital care for undernutrition risk.

Ethical disclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.

Right to privacy and informed consent

The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.

Conflicts of interest

The authors have no conflicts of interest to declare.

References
[1]
L. Sobotka.
Basics in Clinical Nutrition.
4th ed., Czech Republic, (2011), pp. 47-48
[2]
J. Kondrup, S. Allison, M. Elia, B. Vella, M. Plauth.
ESPEN Guidelines for Nutrition Screening 2002.
Clinical Nutrition, 22 (2002), pp. 415-421
[3]
L. Matos, M.A. Teixeira, A. Henriques, M. Tavares, L. Álvares, A. Antunes, T. Amaral.
Nutritional status recording in hospitalized patient notes.
Acta Médica Portuguesa, 20 (2007), pp. 503-510
[4]
H. Lee, S. Kim, Y. LIm, H. Gwon, Y. Kim, J. Ahn, H. Park.
Nutritional status and disease severity in patients with chronic obstructive pulmonary disease (COPD).
Archives of Gerontology and Geriatrics, 56 (2013), pp. 518-523
[5]
B. Gupta, S. Kant, R. Mishra.
Subjective global assessment of nutritional status of chronic obstructive pulmonary disease patients on admission.
The International Journal of Tuberculosis and Lung Disease, 14 (2010), pp. 500-505
[6]
B. Gupta, S. Kant, R. Mishra, S. Verma.
Nutritional status of chronic obstructive pulmonary disease patients admitted in hospital with acute exacerbation.
Journal of Clinical Medicine Research, 2 (2010), pp. 68-74
[7]
E. Lemarie, F. Goldwasser, M. Michallet, C. Beauvillain, X. Hebuterne.
Prevalence of Undernutrition in lung cancer patients: a one-daysurvey.
Journal of Thoracic Oncology, 2 (2007), pp. S840-S841
[8]
M. Elia, L. Zellipour, R. Stratton.
To screen or not to screen for adult Undernutrition?.
Clinical Nutrition, 24 (2005), pp. 867-884
[9]
M. Davies.
Nutritional screening and assessment in cancer-associated Undernutrition.
European Journal of Oncology Nursing, 9 (2005), pp. S64-S73
[10]
S. Miyata, M. Tanaka, D. Ihaku.
Usefulness of the Undernutrition Screening Tool in patients with pulmonar tuberculosis.
Nutrition, 28 (2012), pp. 271-274
[11]
S. Fang, J. Long, R. Tan, H. Mai, W. Lu, F. Yan, J. Peng.
A multicenter assessment of Undernutrition, nutritional risk, and application of nutrition support among hospitalized patients in Guangzhou hospitals.
Asia Pac Journal of Clinical Nutrition, 22 (2013), pp. 54-59
[12]
M. Pirlich, T. Schutz, K. Norman, S. Gastell, LubkeH, S. Bischoff, U. Bolder, T. Frieling, H. Guldenzoph, K. Hahn, K. Jauch, K. Schindler, J. Stein, D. Volkert, A. Weimann, H. Werner, C. Wolf, G. Zurcher, P. Bauer, H. Lochs.
The German hospital Undernutrition study.
Clinical Nutrition, 25 (2006), pp. 563-572
[13]
J. Bauer, S. Capra.
Comparison of a Undernutrition screening tool with subjective assessment in hospitalized patients with cancer – sensitivity and specificity.
Asia Pacific Journal of Clinical Nutrition, 12 (2003), pp. 257-260
[14]
J. White, P. Guenter, G. Jensen, A. Malone, M. Schofield, Academy Undernutrition Work Group, ASPEN Undernutrition Task Force, ASPEN Board of Directors.
Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult undernutrition (undernutrition).
Journal of Parenteral and Enteral Nutrition, 36 (2012), pp. 275-283
[15]
Todorovic V, Russell C, Elia M. The ‘MUST’ explanatory booklet – A guide to the ‘Undernutrition Universal Screening Tool’ for adults. 2003 Disponível em http://www.bapen.org.uk/pdfs/must/must_explan.pdf. Access in 20/05/2013.
[16]
S. Lim, K. Ong, Y. Chan, W. Loke, M. Ferguson, L. Daniels.
Undernutrition and its impact on costs of hospitalization, length of stay, readmission and 3-year mortality.
Clinical Nutrition, 31 (2012), pp. 345-350
[17]
R. Stratton, A. Hackston, D. Longmore, R. Dixon, S. Price, M. Stroud, C. King, M. Elia.
Undernutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘Undernutrition universal screening tool (‘MUST’) for adults.
British Journal of Nutrition, 92 (2004), pp. 799-808
[18]
T.F. Amaral, L.C. Matos, M.M. Tavares, A. Subtil, R. Martins, M. Nazaré, N. Sousa Pereira.
The economic impact of disease-related malnutrition at hospital admission.
Clinical Nutrition, 26 (2007), pp. 778-784
[19]
S. Hossein, B. Amirkalali, N. Nayebi, R. Heshmat, B. Larijani.
Nutrition status of patients during hospitalization, Tehran.
Iran Nutrition in Clinical Practice, 21 (2006), pp. 518-521
[20]
World Medical Association. Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects; 1964. Available in: http://www.wma.net/en/30publications/10policies/b3/index.html. Access in 04/02/2013.
[21]
Elia M. The MUST Report – Nutritional screening of adults: a multidisciplinary responsibility. 2003. Available in: http://www.bapen.org.uk/pdfs/must/must_exec_sum.pdf. Access in 13/11/2013.
[22]
R.D. Lee, D.C. Nieman.
Nutritional Assessment.
6th ed., Boston, (2012), pp. 170-171
[23]
World Health. “Global Database on body mass index”; 2012. Available in http://apps.who.int/bmi/index.jsp. Access in: 13/11/2013.
[24]
L. Lucchin, A. D’Amicis, M. Gentile, N. Battistini, M. Fusco, A. Palmo, M. Muscariotoli, F. Contaldo, E. Cereda.
An Italian investigation on nutritional risk at hospital admission: The PIMAI (Project: Iatrogenic Undernutrition in Italy) study. e-SPEN.
Journal of Clinical Nutrition and Metabolism, 4 (2009), pp. 1-4
[25]
E. Koifman, T. Mashiach, I. Papier, A. Karban, R. Eliakim, I. Chermesh.
Proactive screening in Israel identifies alarming prevalence of Undernutrition among hospitalized patients – action is needed.
Nutrition, 28 (2012), pp. 515-519
[26]
C. Pernil, C. Silveira, T. Marcelino, C. Teixeira, C. Gil, J. Maia, H. Ma, W. Tang, J. Woo.
Predictors of in-hospital mortality of order patients admitted for community-acquired pneumonia.
Age and Ageing, 40 (2011), pp. 736-741
[27]
L. Zhang, Y. Su, C. Wang, Y. Sha, H. Zhu, S. Xie, S. Kwauk, J. Zhang, Y. Lin, C. Wang.
Assessing the nutritional status of elderly Chinese lung cancer patients using the Mini-Nutritional Assessment (MNA®) tool.
Clinical Interventions in Aging, 8 (2013), pp. 287-291
Copyright © 2013. Sociedade Portuguesa de Pneumologia
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?