The screening score of Mini Nutritional Assessment (MNA) is a useful routine screening tool for malnutrition risk in patients on maintenance dialysis
The screening score of Mini Nutritional Assessment (MNA) is a useful routine screening tool for malnutrition risk in patients on maintenance dialysis
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DOI：
10.1371/journal.pone.0229722
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发表时间：
2020-03-04
期刊：
影响因子：
3.7
通讯作者：
Eloot, Sunny
中科院分区：
文献类型：
--
作者：
Holvoet, Els;Vanden Wyngaert, Karsten;Eloot, Sunny
目的营养不良在透析患者中普遍存在，并与发病率和死亡率相关。营养状况可以通过多种生化和物理参数或营养评估分数来评估。这些方法大多数都很昂贵或使用起来很麻烦，并且不适合透析患者的常规重复随访。迷你营养评估 (MNA) 有一个简短的筛查套件 (MNA-SF)，适合作为筛查工具，但尚未在透析患者中得到验证。我们的目的是评估 MNA 是否是识别透析患者营养问题的合适工具。方法在血液透析和腹膜透析患者的横断面多中心队列中评估 MNA、常规生化、身体参数、合并症，并纵向随访 2 年了解死亡率。结果在这个由 216 名患者组成的队列中，随访 750 +/- 350 天时死亡率为 27.3%。 MNA-SF 平均评分为 9.9 +/- 1.8，分别有 30.1%、59.3% 和 10.6% 的患者被归类为营养状况正常、有营养不良风险和营养不良。筛查评分与死亡率相关（HR 0.86，95% CI 0.75-0.98 每点）。以正常营养为参考，有营养不良风险和患有营养不良的患者的调整后死亡率分别为 2.50 (95% CI 1.16-5.37) 和 3.89 (95% CI 1.48-10.13)。在重新校准 MNA 满分针对透析患者某些领域的特异性后，MNA-SF 在满分中对营养不良具有良好的敏感性和特异性（分别为 0.95 和 0.63），并且具有较高的阴性预测值（0.91）。结论 MNA-SF 与透析患者的 2 年死亡率独立相关。它对于排除满分中存在风险或营养不良具有很高的阴性预测价值。因此，可以提倡将其作为透析患者营养状况的筛查工具。
PurposeMalnutrition is prevalent in patients on dialysis and is associated with morbidity and mortality. Nutritional status can be assessed by a variety of biochemical and physical parameters or nutritional assessment scores. Most of these methods are expensive or cumbersome to use and are not suitable for routine repetitive follow-up in dialysis patients. The Mini Nutritional Assessment (MNA) has a short form screening set (MNA-SF), which would be suitable as a screening tool, but has not been validated yet in dialysis patients. We aimed to assess whether the MNA is an appropriate tool for identifying nutritional problems in dialysis patients.MethodMNA, routine biochemistry, physical parameters, comorbidities were assessed in cross-sectional multicentric cohorts of hemodialysis and peritoneal dialysis patients with a longitudinal follow up of 2 years for mortality.ResultsIn this cohort of 216 patients, mortality was 27.3% at a follow up of 750 +/- 350 days. The mean MNA-SF score was 9.9 +/- 1.8, with 30.1%, 59.3% and 10.6% of patients categorized as having normal nutritional status, at risk for malnutrition and malnourished, respectively. The screening score was associated with mortality (HR 0.86, 95% CI 0.75-0.98 per point). With normal nutrition as reference, adjusted mortality was 2.50 (95% CI 1.16-5.37) and 3.89 (95% CI 1.48-10.13) for patients at risk for malnutrition and with malnutrition, respectively. After recalibrating the MNA full score for the specificity of some of its domains for dialysis patients, the MNA-SF had a good sensitivity and specificity for not being well nourished (0.95 and 0.63 respectively) in the full score, and a high negative predictive value (0.91).ConclusionThe MNA-SF is independently associated with 2 year mortality in dialysis patients. It has a high negative predictive value for excluding being at risk or having malnutrition in the full score. Therefore, it can be advocated as a screening tool for nutritional status in dialysis patients.