Five‐year mortality of severely malnourished patients with chronic anorexia nervosa admitted to a medical unit

Abstract

Objective Anorexia nervosa (AN) is associated with one of the highest mortality rates of any psychiatric disorder but limited mortality data were reported for those with extremely severe malnutrition. This study aimed to estimate standardized mortality ratio (SMR), investigate predictive factors of mortality and causes of death among a sample of patients with AN admitted to a specialized clinical nutrition unit (CNU) because of extremely severe malnutrition. Methods Between 11/27/1997 and 01/15/2014, vital status was determined for 384 patients admitted for AN at the first time in the CNU. Sociodemographic, anamnestic, and clinical data were collected. We calculated the SMR. Univariate and multivariate Cox regression analyses were performed to identify mortality predictors. Results Crude mortality rate was 11.5%. (44 deaths) and SMR 15.9 [CI 95% (11.6–21.4)], 5.2 years post inpatient treatment. Mortality predictors at the time of hospitalization were as follows: older age, occurrence of an in‐hospital suicide attempt, transfer to medical intensive care unit and the following somatic complications: frank anemia, dysnatremia, infectious and cardiac complications. Other predictors of mortality were: past or present history of discharge against medical advice, hematological comorbidities (not related to AN). A longer inpatient length of stay was a protective factor. Conclusion Very severely malnourished patients with AN hospitalized in a medical unit because of extremely severe somatic issues have a medium‐term mortality rate higher than the general population and even higher than patients in tertiary specialized ED units. This study highlights predictive factors of mortality that will help clinicians in recognizing and managing patients at risk of death.

The Restrictive Type, Infectious Complications, a Long Duration of Illness Might Predict Nadir Hematological Values Among Individuals With Anorexia Nervosa During the Refeeding Period: A Retrospective Study

“…The association between malnutrition (body mass index, the restrictive type of anorexia nervosa, and duration of illness) and hematological de ciencies in our study is consistent with previous reports [2,3,5,8,9], although these previous studies did not control for potential cofounding factors. What was not previously known is that this relationship further applies to the hematological values during the refeeding period, in which the lowest hematological cell measures are observed.…”

“…Pancytopenia, a decline in all three hematological measures, is also occasionally found in anorexic patients, and its frequency was reported to be 23% among anorexic patients with severe malnutrition [2]. Indeed, anemia is considered one of the predictors of mortality for anorexic patients; the 5-year mortality rate for anorexic patients with severe undernutrition is 11.5%, and their mortality risk is 15 times higher than that in the general population [5]. Regarding life expectancy, Harbottle et al estimated that a woman who has had anorexia nervosa since 15 years of age is likely to live 25 years less than predicted for the normal population [6].…”

Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa

“…an almost 6 times increased risk. In a recent study, after 5 years follow-up the SMR of anorexia nervosa inpatients with (complications of) severe malnutrition was found to be as high as 15.9 (95% CI 11.6–21.4) [ 51 ]. This study population was probably more severely affected than most of the study populations included in the meta-analysis [ 50 ].…”

Self-Reported Lifetime History of Eating Disorders and Mortality in the General Population: A Canadian Population Survey with Record Linkage

“…Evidence has shown that mortality in EDs is influenced by age, sex, and case severity [6,9,16,44]. Generally, older individuals have an elevated risk of mortality for all types of EDs compared to the mortality of younger individuals [8], probably reflecting the strong effect of age and chronicity of illness on mortality.…”

“…These disorders encompass a range of problematic behaviors, including starvation, binge eating, and purging, leading to an increased risk of premature death [4]. Many factors in these patients have also been identified as predictors of mortality, such as type of ED diagnosis, low body mass index (BMI), suicide behaviors, alcohol abuse, and comorbidities [5][6][7]. In addition, the age of onset and age of treatment are also two important death-predictive factors in patients with EDs, as evidence has shown that older individuals (25-44 age group) have an elevated risk of mortality for all types of EDs compared to youth (15-24 age group) [8].…”