The nutritional strategy: Four questions predict morbidity, mortality and health care costs
The nutritional strategy: Four questions predict morbidity, mortality and health care costs
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DOI：
10.1016/j.clnu.2013.09.008
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发表时间：
2014-08-01
影响因子：
6.3
通讯作者：
Ranhoff, Anette Hylen
中科院分区：
文献类型：
--
作者：
Tangvik, Randi J.;Tell, Grethe S.;Ranhoff, Anette Hylen
背景资料：住院病人的营养护理是潜在的重要，但challenging.Objective：探讨营养状况和临床outcomes.Methods之间的关联：八个患病率调查在豪克兰大学医院，挪威，在2008-2009年。根据营养风险筛查（NRS 2002）工具，共有3279例患者被分类为营养风险或非营养风险。NRS 2002的前四个问题评估了饮食摄入、体重减轻、体重指数（BMI）和疾病严重程度。营养风险患者的校正平均住院天数为8.3天，无营养风险患者为5.0天（p < 0.001）。在调整后的模型中，营养风险患者的一年死亡率增加（OR 4.07，95% CI 2.90-5.70），发病率（OR 1.59，95%CI 1.18-2.13），分别为1.24（95% CI 1.16-1.32）倍于在前三年和随后一年内有新入院的可能性，与没有风险的患者相比。对前四个问题的“积极”回答与发病率和死亡率的风险增加有关。最后几周饮食摄入减少的患者1年死亡率的OR为1.72（95%CI 1.03 - 2.85）。在所有最初的四个问题的积极答案的患者有十倍的死亡风险增加次年，OR 13.0（95%CI 4.52-37.6）。结论：2002年的NRS的四个初始问题鲁棒地确定营养风险和住院，发病率和最重要的住院患者的死亡率的强有力的预测。因此，这些简单而简短的问题是随后不良结果的有力指标。(C)2013爱思唯尔有限公司和欧洲临床营养与代谢学会。All rights reserved.
Background: Nutritional care for hospital in-patients is potentially important but challenging.Objective: To investigate the association between nutritional status and clinical outcomes.Methods: Eight prevalence surveys were performed at Haukeland University Hospital, Norway, during 2008-2009. In total 3279 patients were classified as being at nutritional risk or not according to the Nutritional Risk Screening (NRS 2002) tool. The initial four questions of NRS 2002 assess dietary intake, weight loss, body mass index (BMI) and illness severity.Results: The overall prevalence of nutritional risk was 29%. Adjusted mean days for hospitalisation was 8.3 days for patients at nutritional risk and 5.0 days for patients not at risk (p < 0.001). In adjusted models, patients at nutritional risk had increased one-year mortality (OR 4.07, 95% CI 2.90-5.70), morbidity (OR 1.59, 95% CI 1.18-2.13), and were 1.24 (95% CI 1.16-1.32) times more likely to have had a new admission during the three previous years and the one subsequent year, compared to patients not at risk. A 'positive' response to the initial four questions was associated with increased risk of morbidity and mortality. Patients with a reduced dietary intake during the last weeks had OR 1.72 (95% CI 1.03 -2.85) for one-year mortality. Patients with a positive answer on all the initial four questions had ten times increased risk for mortality the following year, OR 13.0 (95% CI 4.52-37.6).Conclusion: The four initial questions of the NRS 2002 robustly identify nutritional risk and were strong predictors of hospitalisation, morbidity and most importantly mortality among hospitalised patients. Thus, these simpler and short questions are robust indicators for subsequent poor outcomes. (C) 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.