Nutrition screening tools and the prediction of clinical outcomes among Chinese hospitalized gastrointestinal disease patients

Background/Objective: Nutritional Risk Screening 2002 (NRS-2002) and Subjective Global Assessment (SGA) are widely used screening tools, but there is no gold standard for identifying nutritional risk. The purpose of this study was to assess the nutritional risk among hospitalized gastrointestinal disease patients, the agreement between NRS-2002 and SGA, and to compare the clinical outcome predicting capacity of them. Subjects/Method: This study was an analysis of secondary data including 332 patients collected by gastrointestinal department of Peking Union Medical College Hospital (PUMCH). All questions of NRS-2002 and SGA, complications, length of hospitalization stay (LOS), cost, and death were collected. To assess the agreement between the tools, κ statistic was adopted. Before assessing the performance of NRS-2002 and SGA in predicting LOS and cost using linear regression, full and saturated model was compared via the global f-test. The complications and death predicting capacity of tools was assessed using receiver operating characteristic curves. Results: NRS-2002 and SGA identified nutritional risk at 59.04% and 45.18%. The agreement between two tools was moderate (κ index \u3e0.50) for all age groups except individuals aged ≤ 20, which was slight agreement (κ index 0.087). The saturated model did not improve the outcomes of LOS and cost. There was no significant difference in the association of one step of NRS-2002 and LOS (B=2.127, p=0.002) and the association of one step of SGA and LOS (B=2.296, p=0.001). One step of SGA was associated with a relatively large increase in cost (B=0.272, p=0.001) compared to one step of NRS-2002 (B=0.086, p=0.000), but the difference was not significant. There was no difference of NRS-2002 (infectious complications: 0.615, death 0.810) and SGA (infectious complications: 0.600, death: 0.846) in predicting infectious complication and death, but NRS-2002 (0.738) had larger areas under ROC curve than SGA (0.552) in predicting non-infectious complications. Conclusion: The prevalence of nutritional risk of hospitalized patients was high. There was moderate agreement between NRS-2002 and SGA for all ages except ≤ 20 age group. NRS-2002 and SGA have similar capacity to predict LOS, cost, infectious complications and death, but NRS-2002 seems to perform better in predicting non-infectious complications

Prediction of early- and long-term mortality in adult patients acutely admitted to internal medicine: NRS-2002 and beyond

8noBACKGROUND & AIMS: In hospitalized patients malnutrition is a risk factor for adverse clinical outcomes. The Nutritional Risk Screening 2002 (NRS-2002) represents a quick and simple tool to identify malnutrition risk in this population. No study tested the predictive power of NRS-2002 on mortality adjusting for confounders related to patient's complexity, thus considering conditions such as functional status, illness-related severity and inflammation. The aim of this study was to explore the independent prognostic power and the relative weight of NRS-2002 screening tool to predict inhospital and post-discharge (up to 1 year) mortality, adjusting for variables representing the non-disease specific multidimensional complexity of patients admitted to Internal Medicine wards. METHODS: Retrospective observational study including 5698 consecutive patients acutely admitted to an Internal Medicine Department. Logistic regression models were run to test the predictive power of the NRS-2002 on patient mortality at different time intervals, adjusted for age, sex, Charlson comorbidity index, Glasgow Prognostic Score (GPS), BUN/creatinine ratio, Modified Early Warning Score (MEWS), and Norton index. The performance of the logistic models in predicting mortality was measured through the c-statistic. The different time of death between patients scored upon admission as NRS-2002 < 3 or ≥3 was evaluated through crude Kaplan-Meier curves and multivariate Cox proportional hazard analysis. RESULTS: Patients classified at high malnutrition risk (NRS-2002 ≥ 3) showed a higher and earlier mortality (Log-rank test: p < 0.001) compared to subjects in the NRS-2002 "low-risk" group. NRS-2002 ≥ 3 was an independent significant (p < 0.01) predictor of mortality in logistic regression at every time interval. Among the considered covariates, Charlson index, GPS and Norton scale showed a steadily higher OR than NRS-2002 in predicting both early and late mortality. The multivariate models demonstrated a very good discrimination for hospital and mid-term (up to 90 days) mortality. Being classified at risk for malnutrition (NRS-2002 ≥ 3) on admission independently increased the risk of one-year death (HR = 1.431; 95% CI: 1.277-1.603; p < 0.001) compared to the patients who were scored at low malnutrition risk. CONCLUSIONS: Malnutrition risk identified upon hospital admission by NRS-2002 independently contributes to early and late mortality in a population including a majority of elderly. However, risk of malnutrition has to be considered according to other factors related to comorbidities, functional status, illness severity and inflammation which reciprocally interact, concurring at worsening patient's outcome.partially_openopenSanson, Gianfranco; Sadiraj, Marina; Barbin, Ilaria; Confezione, Christian; De Matteis, Daniela; Boscutti, Giuliano; Zaccari, Michele; Zanetti, Michela*Sanson, Gianfranco; Sadiraj, Marina; Barbin, Ilaria; Confezione, Christian; DE MATTEIS, Daniela; Boscutti, Giuliano; Zaccari, Michele; Zanetti, Michel

AIWW: a new nutrition-screening tool for the oncologic population

Malnutrition is a common comorbidity among patients with cancer. However, no nutrition-screening tool has been recognized in this population. A quick and easy screening tool for nutrition with high sensitivity and easy-to-use is needed. Based on the previous 25 nutrition-screening tools, the Delphi method was made by the members of the Chinese Society of Nutritional Oncology to choose the most useful item from each category. According to these results, we built a nutrition-screening tool named age, intake, weight, and walking (AIWW). Malnutrition was defined based on the scored patient-generated subjective global assessment (PG-SGA). Concurrent validity was evaluated using the Kendall tau coefficient and kappa consistency between the malnutrition risks of AIWW, nutritional risk screening 2002 (NRS-2002), and malnutrition screening tool (MST). Clinical benefit was calculated by the decision curve analysis (DCA), integrated discrimination improvement (IDI), and continuous net reclassification improvement (cNRI). A total of 11,360 patients (male, n=6,024 (53.0%) were included in the final study cohort, and 6,363 patients had malnutrition based on PG-SGA. Based on AIWW, NRS-2002, and MST, 7,545, 3,469, and 1,840 patients were at risk of malnutrition, respectively. The sensitivities of AIWW, NRS-2002, and MST risks were 0.910, 0.531, and 0.285, and the specificities were 0.768, 0.946, and 0.975. The Kendall tau coefficients of AIWW, NRS-2002, and MST risks were 0.588, 0.501, and 0.326, respectively. The area under the curve of AIWW, NRS-2002, and MST risks were 0.785, 0.739, and 0.630, respectively. The IDI, cNRI, and DCA showed that AIWW is non-inferior to NRS-2002 (IDI: 0.002 (−0.009, 0.013), cNRI: −0.015 (−0.049, 0.020)). AIWW scores can also predict the survival of patients with cancer. The missed diagnosis rates of AIWW, NRS-2002, and MST were 0.09%, 49.0%, and 73.2%, respectively. AIWW showed a better nutrition-screening effect than NRS-2002 and MST for patients with cancer and could be recommended as an alternative nutrition-screening tool for this population

Diagnostic performance of the Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients - a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The usefulness of the nutritional screening tool Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) relative to Nutritional Risk Screening 2002 (NRS 2002) remains untested. Here we attempted to fill this gap by testing the diagnostic performance and user-friendliness of the MEONF-II and the NRS 2002 in relation to the Mini Nutritional Assessment (MNA) among hospital inpatients.</p> <p>Methods</p> <p>Eighty seven hospital inpatients were assessed for nutritional status with the 18-item MNA (considered as the gold standard), and screened with the NRS 2002 and the MEONF-II.</p> <p>Results</p> <p>The MEONF-II sensitivity (0.61), specificity (0.79), and accuracy (0.68) were acceptable. The corresponding figures for NRS 2002 were 0.37, 0.82 and 0.55, respectively. MEONF-II and NRS 2002 took five minutes each to complete. Assessors considered MEONF-II instructions and items to be easy to understand and complete (96-99%), and the items to be relevant (87%). For NRS 2002, the corresponding figures were 75-93% and 79%, respectively.</p> <p>Conclusions</p> <p>The MEONF-II is an easy to use, relatively quick and sensitive screening tool to assess risk of undernutrition among hospital inpatients. With respect to user-friendliness and sensitivity the MEONF-II seems to perform better than the NRS 2002, although larger studies are needed for firm conclusions. The different scoring systems for undernutrition appear to identify overlapping but not identical patient groups. A potential limitation with the study is that the MNA was used as gold standard among patients younger than 65 years.</p

Malnutrition Incidence Among Inpatients: A Cross-Sectional Retrospective Study

Malnutrition in hospital is a significant problem which involves clinical complication risks, lengthened hospital stay and worsening prognosis. In order to overcome this problem, it is important to identify malnutrition in patients. The aim of this study was to retrospectively research the malnutrition risk of patients at time of admission and to create awareness about the importance of malnutrition screening. This research is a cross-sectional descriptive retrospective study which screened inpatients in İstanbul Sultan Abdülhamid Han Education and Research hospital from August 2018 to January 2019. Research data and NRS-2002 scores were retrospectively gathered from patient files. Between the dates of the study, a total of 10,060 patients stayed in the hospital and of these 490 (4.9%) were identified to be malnourished. Of these patients, 0.87% developed malnutrition after admission. The clinic with highest malnutrition was the anesthesia intensive care (25.9%). There was a significant increase identified in NRS-2002 scores with age (p=0.001); as NRS-2002 scores increased the mortality rates were found to significantly increase (p=0.015). The mortality in the patient group with NRS-2002 scores of 7 was 50%. Malnutrition screening will contribute to monitoring malnourished patients from time of admission and reducing mortality rates. According to the results of our study, the malnutrition risk is higher among elderly patients and as NRS-2002 score increases mortality increases. Due to this correlation between inpatient NRS-2002 scores and mortality, it was concluded that rapid screening and close surveillance of nutritional interventions for patients with high scores are important in terms of mortality.. Keywords: malnutrition, NRS, length of stay, nutrition DOI: 10.7176/JHMN/76-10 Publication date:June 30th 202

Utility of nutritional evaluation for the clinical risk assessment of postoperative complications. Does oncology need the NRS 2002 scale?

Introduction. Malnutrition accompanies many cancers, especially those of the gastrointestinal tract, and significantly raises the risk of postoperative complications in cancer surgery. In Poland, hospitals are legally obliged to evaluate the nutritional status of their patients; one of the assessment tools used for this purpose is the NRS 2002 scale. Aim. The primary objective of the study is to analyze the utility of the NRS 2002 scale in the risk assessment of posto­perative complications in gastrointestinal cancers. In addition, the authors propose to determine whether the legal requirement to conduct nutritional assessments among hospitalized patients is complied with in clinical practice and to evaluate the risk of malnutrition in the study group. Materials and methods. A detailed assessment was conducted on 226 patients who underwent surgery for upper (95 patients) and lower (131 patients) GI tract cancers in 2015. The risk of complications was analyzed based on the nutritional risk score (NRS 2002) and the levels of albumin and total proteins in the serum before surgery. Compliance with the obligation to carry out nutritional assessments was evaluated on breast and GI cancer patients treated with surgery at the Institute of Oncology in Warsaw in two successive years. Results. An NRS 2002 score of ≥ 3 was shown to predict postoperative complications for both upper GI tract (p < 0.001) and colorectal cancers (p < 0.001). In upper GI cancers, complications were also more frequently observed at lower albumin (p = 0.018) and total protein (p = 0.025) levels in the serum. Conclusion. The analysis shows that the NRS 2002 scale is useful in predicting the risk of postoperative complications in the treatment of upper and lower GI tract cancers

STUDI KOMPARASI METODE SKRINING MALNUTRITION SCREENING TOOLS, MALNUTRITION UNIVERSAL SCREENING TOOLS DAN NUTRITIONAL RISK SCREENING 2002 DALAM MEMPREDIKSI RISIKO MALNUTRISI PADA PASIEN RAWAT INAP DI BANGSAL PENYAKIT DALAM RSUD IR. SOEKARNO SUKOHARJO

ABSTRACT DINIX OKTAVIAN MINANGSARI. J 310 150 113 COMPARATIVE STUDY OF MALNUTRITION SCREENING TOOLS, MALNUTRITION UNIVERSAL SCREENING TOOLS AND NUTRITIONAL RISK SCREENING 2002 FOR PREDICTING THE RISK OF MALNUTRITION IN ADULT INPATIENTS IN INTERNAL MEDICINE WARDS AT RSUD IR. SOEKARNO SUKOHARJO Introduction: malnutrition is a condition where body has excess or deficiency of nutrient in relative or absolute term. Malnourished inpatients can have an impact on increasing morbidity and mortality. Based on preliminary survey result on February – April 2018 adult inpatients in internal medicine wards were 178 patients among 54 patients experiencing malnutrition, so nutritional screening is an important for the first step to detect the risk of malnutrition in patient with a variety of diseases Objective: The study aimed to determine differences in screening tools MST, MUST and NRS 2002 in detecting the risk of malnutrition in inpatient with a variety diseases in internal medicine wards at RSUD Ir. Soekarno Sukoharjo Research Methodology: The Research Methode is observational with a crosssectional approach. Sample of 48 respondents were taken by consecutive sampling technique and pay attention to inclusion and exclusion criteria. Data collection was obtained by screening form MST, MUST and NRS 2002. Data processing was displayed in the table frequency distribution. Results: Screening MST was better for predicting malnutrition risk on respondents chronic kidney disease with hemodialisa, hematemesis, chelpagia and fistula. Screening MUST was better for predicting malnutrition risk on respondents colic abdomen and febris, while screening NRS 2002 better for predicting malnutrition risk on respondents melena. Conclusion: There is a difference between MST, MUST and NRS 2002 for predicting malnutrition risk screening method for NRS 2002 in inpatient with various diseases in internal medicine wards at RSUD Ir. Soekarno Sukoharjo Keywords: MST, MUST, Malnutrition Risk, NRS 200

Nutritional Risk, Health Outcomes, and Hospital Costs Among Chinese Immobile Older Inpatients: A National Study

Purpose: Evidence of the impact of nutritional risk on health outcomes and hospital costs among Chinese older inpatients is limited. Relatively few studies have investigated the association between clinical and cost outcomes and nutritional risk in immobile older inpatients, particularly those with neoplasms, injury, digestive, cardiac, and respiratory conditions. Methods: This China-wide prospective observational cohort study comprised 5,386 immobile older inpatients hospitalized at 25 hospitals. All patients were screened for nutritional risk using the Nutrition Risk Screening (NRS 2002). A descriptive analysis of baseline variables was followed by multivariate analysis (Cox proportional hazards models and generalized linear model) to compare the health and economic outcomes, namely, mortality, length of hospital stay (LoS), and hospital costs associated with a positive NRS 2002 result. Results: The prevalence of a positive NRS 2002 result was 65.3% (n = 3,517). The prevalence of “at-risk” patients (NRS 2002 scores of 3+) was highest in patients with cardiac conditions (31.5%) and lowest in patients with diseases of the respiratory system (6.9%). Controlling for sex, age, education, type of insurance, smoking status, the main diagnosed disease, and Charlson comorbidity index (CCI), the multivariate analysis showed that the NRS 2002 score = 3 [hazard ratio (HR): 1.376, 95% CI: 1.031–1.836] were associated with approximately a 1.5-fold higher likelihood of death. NRS 2002 scores = 4 (HR: 1.982, 95% CI: 1.491–2.633) and NRS scores ≥ 5 (HR: 1.982, 95% CI: 1.498–2.622) were associated with a 2-fold higher likelihood of death, compared with NRS 2002 scores <3. An NRS 2002 score of 3 (percentage change: 16.4, 95% CI: 9.6–23.6), score of 4 (32.4, 95% CI: 24–41.4), and scores of ≥ 5 (36.8, 95% CI 28.3–45.8) were associated with a significantly (16.4, 32.4, and 36.8%, respectively) higher likelihood of increased LoS compared with an NRS 2002 scores <3. The NRS 2002 score = 3 group (17.8, 95% CI: 8.6–27.7) was associated with a 17.8%, the NRS 2002 score = 4 group (31.1, 95% CI: 19.8–43.5) a 31.1%, and the NRS 2002 score ≥ 5 group (44.3, 95% CI: 32.3–57.4) a 44.3%, higher likelihood of increased hospital costs compared with a NRS 2002 scores <3 group. Specifically, the most notable mortality-specific comorbidity and LoS-specific comorbidity was injury, while the most notable cost-specific comorbidity was diseases of the digestive system. Conclusions: This study demonstrated the high burden of undernutrition at the time of hospital admission on the health and hospital cost outcomes for older immobile inpatients. These findings underscore the need for nutritional risk screening in all Chinese hospitalized patients, and improved diagnosis, treatment, and nutritional support to improve immobile patient outcomes and to reduce healthcare costs

Impact of malnutrition on postoperative delirium development after on pump coronary artery bypass grafting

Background & aims: Even though malnutrition is frequently observed in cardiac population outcome data after cardiac surgery in malnourished patients is very rare. No thorough research was done concerning the impact of malnutrition on neuropsychological outcomes after cardiac surgery. The aim of our study was to analyze the incidence of postoperative delirium development in malnourished patients undergoing on pump bypass grafting. Methods: We performed a cohort study of adults admitted to Vilnius University Hospital Santariskiu Clinics for elective coronary artery bypass grafting. The nutritional status of the patients was assessed by Nutritional Risk Screening 2002 (NRS-2002) questionnaire the day before surgery. Patients were considered as having no risk of malnutrition when NRS-2002 score was less than 3 and at risk of malnutrition when NRS-2002 score was ≥3. During ICU stay patients were screened for postoperative delirium development using the CAM-ICU method. and divided into two groups: delirium and non delirium. The statistical analysis was preformed to evaluate the differences between the two independent groups. The logistic regression model was used to evaluate the potential preoperative and intraoperative risk factors of postoperative delirium. Results: Ninety-nine patients were enrolled in the study. Preoperative risk of malnutrition was detected in 24 % (n = 24) of the patients. The incidence of early postoperative delirium in overall study population was 8.0 % (n = 8). The incidence of the patients at risk of malnutrition was significantly higher in the delirium group (5 (62.5 %) vs 19 (20.9 %), p <0.0191). In multivariate logistic regression analysis risk of malnutrition defined by NRS 2002 was an independent preoperative and intraoperative risk factor of postoperative delirium after coronary artery bypass grafting (OR: 6.316, 95 % CI: 1.384-28.819 p = 0.0173). Conclusions: Preoperative malnutrition is common in patients undergoing elective coronary artery bypass grafting. Nutrition deprivation is associated with early postoperative delirium after on pump coronary artery bypass grafting

Relationship Between Malnutrition Risk, Activities of Daily Living, and Adaptation to Chronic Diseases in Older People with Chest Diseases

Introduction. The increased risk of malnutrition in older people may have significant impacts on chronic disease management and quality of life. This study aimed to investigate the relationship between chronic diseases, activities of daily living (ADLs), and malnutrition risk. Methods. This cross-sectional, correlational study was conducted on 352 patients over 65 years old, who had a chronic disease for at least one year and were admitted to Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey. The data were collected using the Descriptive Information Form, Adaptation to Chronic Illness Scale (ACIS), Nutrition Risk Screening-2002 (NRS-2002), and Katz Activities of Daily Living (Katz ADL) scale. Results. The mean age of the participants was 70.65±4.18 years. All participants were at risk of malnutrition according to the NRS-2002 assessment, 29% were independent, and 35.8% were partially dependent based on the Katz ADL scale assessment. The ACIS score was 82.83±13.88. Multivariate linear regression analysis revealed that age, disease duration, perceived disease knowledge, and interference from the disease with planned activities were significant positive predictors of ACIS, while hospitalization in the last 6 months, the number of meals per day, difficulty in meeting personal care needs, and NRS-2002 were significant negative predictors of ACIS (p&lt;0.05). Conclusions. Despite the unexpected homogeneity in malnutrition risk, the NRS-2002 score emerged as a negative predictor of chronic disease adaptation. Furthermore, recent hospital admissions, daily meal consumption, and impairment in self-care were also found to have a negative influence, while age, disease duration (in years), appropriate disease knowledge, and the absence of interference from the disease with planned activities demonstrated a positive impact on chronic disease adaptation