Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial
Nutritional risk screening (NRS 2002) is a strong and modifiable predictor risk score for short-term and long-term clinical outcomes: secondary analysis of a prospective randomised trial
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DOI：
10.1016/j.clnu.2019.11.041
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发表时间：
2020-09-01
影响因子：
6.3
通讯作者：
Schuetz, Philipp
中科院分区：
文献类型：
--
作者：
Hersberger, Lara;Bargetzi, Laura;Schuetz, Philipp
导言：2002年营养风险筛查（NRS 2002）确定了营养不良风险患者。我们研究了预后的影响，这个分数方面的短期和长期的临床结果，在一个良好的特点队列的医疗住院患者从以前的trial.Methods：这是一个次要的分析，一个cancelator发起的，前瞻性随机对照多中心试验在瑞士（EFFORT），比较个性化的营养支持干预的效果与标准的护理。我们调查了入院NRS和几个短期和长期的结果之间的关联，使用多变量回归analysis.Results：在2028例患者中，31%的NRS为3，38%的4和31%的5点，477（24%）在180天的随访期间死亡。NRS每增加一个点，我们发现30天死亡率（调整后的风险比（HR）1.22（95%CI 1.00至1.48），p = 0.048）和180天死亡率（调整后的HR 1.37（95%CI 1.22至1.55），p < 0.001）的风险逐步增加。NRS与住院时间（NRS每增加一分，调整后差异为0.60天，95%CI 0.23 - 0.97，p = 0.002）和180天时的功能结果（NRS每增加一分，调整后Barthel指数下降-4.49，95%CI-6.54 -2.45，p < 0.001）相关。在亚组分析中，接受营养支持的患者NRS和短期不良结局的相关性不太明显（干预组）与对照组患者相比（30天死亡率的校正HR为1.12 [95%CI 0.83至1.52，p = 0.454] vs. 1.33 [95%CI 1.02至1.72，p = 0.032]）。NRS是180天内营养不良相关死亡率和不良结局的强大且独立的风险评分。我们的数据提供了强有力的证据表明，营养风险是可以改变的，可以通过提供足够的营养支持来降低。(c)2019年爱思唯尔有限公司和欧洲临床营养与代谢学会。All rights reserved.
Introduction: The Nutritional Risk Screening 2002 (NRS 2002) identifies patients at risk of malnutrition. We studied the prognostic implications of this score with regard to short-term and long-term clinical outcomes in a well-characterised cohort of medical inpatients from a previous trial.Methods: This is a secondary analysis of an investigator-initiated, prospective randomised controlled multicenter trial in Switzerland (EFFORT) that compared the effects of an individualised nutritional support intervention with standard of care. We investigated associations between admission NRS and several short-term and long-term outcomes using multivariable regression analyses.Results: Of the 2028 patients, 31% had an NRS of 3, 38% of 4 and 31% of 5 points, and 477 (24%) died during the 180 days of follow-up. For each point increase in NRS, we found a stepwise increase in risk of 30-day mortality (adjusted Hazard Ratio (HR) 1.22 (95% CI 1.00 to 1.48), p = 0.048) and 180-day mortality (adjusted HR 1.37 (95% CI 1.22 to 1.55), p < 0.001). NRS was associated with length of hospital stay (adjusted difference of 0.60 days per NRS point increase, 95%CI 0.23 to 0.97, p = 0.002) and functional outcomes at 180 days (adjusted decrease in Barthel index of-4.49 points per NRS point increase, 95%CI-6.54 to-2.45, p < 0.001). In a subgroup analysis, associations of NRS and short-term adverse outcomes were less pronounced in patients receiving nutritional support (intervention group) compared to control group patients (adjusted HR for 30-day mortality 1.12 [95%CI 0.83 to 1.52, p = 0.454] vs. 1.33 [95%CI 1.02 to 1.72, p = 0.032]).Conclusion: The NRS is a strong and independent risk score for malnutrition-associated mortality and adverse outcomes over 180 days. Our data provide strong evidence that the nutritional risk, however, is modifiable and can be reduced by the provision of adequate nutritional support. (c) 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.