Day-7 caloric intake as an early dynamic prognostic marker for subsequent mortality in older patients with dysphagia: a landmark cohort analysis

Vollständiger Abstract

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Background Early nutritional status may influence prognosis in older adults with dysphagia receiving artificial nutrition. However, the predictive value of caloric intake shortly after initiation of enteral or parenteral nutrition remains unclear. This study aimed to investigate the association between day-7 caloric intake and subsequent all-cause mortality in older Japanese patients with dysphagia and assess its potential as an early dynamic prognostic marker. Methods We conducted a day-7 landmark cohort analysis of 246 older adults who survived beyond 7 days after initiation of percutaneous endoscopic gastrostomy (PEG) or total parenteral nutrition (TPN). Day-7 caloric intake was analyzed both as a continuous variable (per 100 kcal/day) and categorically (<900 vs. ≥900 kcal/day). Multivariable Cox proportional hazards models adjusted for age, sex, nutritional route, severe dementia, aspiration pneumonia, chronic heart failure, serum albumin, hemoglobin, C-reactive protein, and Clinical Frailty Scale were used to estimate hazard ratios (HRs) for subsequent all-cause mortality. Kaplan–Meier survival curves, subgroup analyses, and time-dependent receiver operating characteristic (ROC) curves at 365 days were applied to evaluate robustness and predictive discrimination. Results Higher day-7 caloric intake was consistently associated with lower subsequent all-cause mortality across all models. Each 100 kcal/day increase was associated with lower subsequent mortality in the fully adjusted model (HR, 0.82; 95% CI 0.72–0.93; P = 0.002). In secondary categorical analysis, patients receiving ≥900 kcal/day had lower mortality than those with <900 kcal/day (HR, 0.47; 95% CI 0.26–0.83; P = 0.010). Kaplan–Meier curves showed higher survival probability in the high-intake group ( P = 0.01), and subgroup analyses showed no statistically significant interactions across prespecified strata (all P for interaction > 0.05). Time-dependent ROC analysis showed a modest increase in AUC after adding day-7 caloric intake to the baseline model, indicating improved predictive discrimination. Conclusion Among older patients with dysphagia who survived beyond the day-7 landmark, higher recorded day-7 caloric intake was associated with lower subsequent all-cause mortality. Day-7 caloric intake may therefore serve as an early dynamic prognostic marker for risk stratification in this population. Future multicenter prospective studies are warranted to validate these findings and explore whether early nutritional optimization can improve survival and patient-centered outcomes.