Role of nutritional status as predictor of survival in oesophageal cancer treated with definitive chemoradiation (dCRT): outcome from SCOPE1, a phase II/III randomised trial of dCRT +/- cetuximab.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 103-103
Author(s):  
Samantha Cox ◽  
Ceri Powell ◽  
Ben Carter ◽  
Chris Hurt ◽  
Somnath Mukherjee ◽  
...  
Keyword(s):  
Oesophageal Cancer ◽  
Nutritional Assessment ◽  
Risk Index ◽  
Randomised Trial ◽  
Nutritional Intervention ◽  
Nutritional Risk ◽  
Tube Placement ◽  
Dietary Advice ◽  
Oral Supplementation ◽  
Nutritional Risk Index

103 Background: Malnutrition is common in oesophageal cancer and may be related to the disease or treatment. We aimed to identify nutritional prognostic factors and the outcome of nutritional intervention in patients recruited to the SCOPE1 trial. Methods: 258 patients were randomly allocated to dCRT with or without the addition of cetuximab. Data was collected prior to induction chemotherapy (iCT) and before commencing concurrent CRT. Nutritional Risk Index (NRI) was calculated and categorised; ≥ 100 (no risk of malnutrition), 97.5-100 (mild risk), and < 97.5 (moderate to severe risk). The maximal nutritional intervention (MNI) received was classified as: none, dietary advice, oral supplementation or major intervention (enteral feeding/tube placement). Univariate and multivariate analyses using Cox proportional hazard modelling were conducted to identify predictive factors and important interactions involving MNI. Results: An NRI score < 100 at baseline strongly predicted reduced median overall survival (OS) in multivariate analysis (HR = 12.45, 95% CI 5.24 – 29.57; p = < 0.001). Furthermore, OS was improved in this group if they received dietary advice (HR = 0.12, p = 0.004), oral supplementation (HR = 0.13, p = < 0.001) or major intervention (HR = 0.13, p = 0.003) prior to commencement of iCT, but there was no benefit if intervention occurred after commencement of iCT. Patients on cetuximab arm undergoing major intervention had worse outcomes compared to control (13 months vs 28 months, p = 0.003). Conclusions: Assessment and correction of poor nutritional state at baseline may improve survival outcomes in oesophageal cancer patients treated with dCRT. The benefit of intervention is no longer observed once treatment has commenced, highlighting the need for early nutritional assessment and intervention. Reason for poor OS in patients on cetuximab requiring major intervention is unclear. Clinical trial information: 47718479.

scholarly journals Preoperative Nutritional Status and Its Consequences on Abdominal Surgery in Wolaita Zone, Southern Ethiopia: An Institution-Based Observational Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Leila Hussen ◽  
Elazar Tadesse ◽  
Dereje Yohannes Teferi
Keyword(s):  
Wound Healing ◽  
Observational Study ◽  
Nutritional Status ◽  
Abdominal Surgery ◽  
Nutritional Assessment ◽  
Risk Index ◽  
Nutritional Risk ◽  
Southern Ethiopia ◽  
Increased Risk ◽  
Nutritional Risk Index

This study aimed to determine the prevalence of malnutrition and its association with wound healing and length of hospitalization among patients undergoing abdominal surgery admitted to hospitals in the Wolaita zone in southern Ethiopia. Methods. An institution-based prospective observational study was conducted in three hospitals in the Wolaita zone from August to October 2016. All eligible individuals aged between 19 and 55 years were recruited in this study. Anthropometric and biochemical analyses, such as serum albumin (Alb) and total lymphocyte count (TLC), were taken for nutritional assessment during the preoperative period. Quantitative variables were compared using Student’s t test. Cox’s regression was employed to determine which variables were possible risk factors for poor wound healing. Results. A total of 105 patients aged 19 to 55 with a mean age (±SD) of 34 ± 9.6 years were included, and the prevalence of preoperative malnutrition was 27.6%, 87%, according to BMI and nutritional risk index, respectively. Poor wound healing was significantly associated with underweight patients (BMI < 18.5 kg/m2) (AHR: 6.5 : 95%CI: 3.312.9), postoperative weight loss (AHR: 4.9; 95%CI: 2.8–8.5), and nutritional risk index (NRI) less than 97.5 (AHR 1.8; 95% CI: 1.09–3.1). Conclusion. The prevalence of malnutrition is high in our study setup; this is associated with an increased risk of adverse postoperative outcomes. Therefore, our results emphasize the need of routine preoperative nutritional assessment, optimizing nutritional status of patients and postoperative nutritional support.

The Effect of Malnutrition on Morbidity after Surgery for Chronic Pancreatitis

2005 ◽  
Vol 71 (6) ◽  
pp. 466-473 ◽  
Author(s):  
Thomas Schnelldorfer ◽  
David B. Adams
Keyword(s):  
Chronic Pancreatitis ◽  
Nutritional Assessment ◽  
Risk Index ◽  
Protein Energy Malnutrition ◽  
Infectious Complications ◽  
Nutritional State ◽  
Nutritional Risk ◽  
Operative Morbidity ◽  
Lateral Pancreaticojejunostomy ◽  
Nutritional Risk Index

Protein-energy malnutrition is a notable problem in the management of patients with chronic pancreatitis. The effect of malnutrition on pancreatic surgery is not well known. The records of 313 consecutive patients who underwent lateral pancreaticojejunostomy (LPJ, n = 152), pancreaticoduodenectomy (PD, n = 78), or distal pancreatectomy (DP, n = 83) for chronic pancreatitis were retrospectively reviewed and analyzed. Subjective Global Assessment, Nutritional Risk Index, and Instant Nutritional Assessment were used to assess the nutritional state. An average of all three nutritional indexes was established, and patients were categorized into well nourished (n = 101) as well as mild (n = 91), moderate (n = 94), and severe malnourished (n = 27). Poor nutritional state was associated with an increase in postoperative complication rate (LPJ: well nourished 14%, mild 25%, moderate 31%*, severe 50%*; PD: well nourished 44%, mild 44%, moderate 60%, severe 88%*; DP: well nourished 17%, mild 13%, moderate 30%, severe 55%*; * P < 0.045 vs well nourished). Low serum albumin levels also increased operative morbidity. The increase in morbidity was reflected by a higher rate of infectious complications as well as increased ICU stay. Body mass index and weight loss did not contribute to change in outcome. Malnutrition was associated with a higher incidence of postoperative complications after surgery for chronic pancreatitis. An increase in operative morbidity might be related to decreased protein synthesis and impaired immunocompetence.

scholarly journals Evaluation of the effectiveness of eight screening tools in detecting risk of malnutrition in cirrhotic patients: the KIRRHOS study

2019 ◽  
Vol 122 (12) ◽  
pp. 1368-1376 ◽  
Author(s):  
Alexandra Georgiou ◽  
Georgios V. Papatheodoridis ◽  
Alexandra Alexopoulou ◽  
Melanie Deutsch ◽  
Ioannis Vlachogiannakos ◽  
...  
Keyword(s):  
Liver Disease ◽  
Screening Tool ◽  
Nutritional Assessment ◽  
Risk Index ◽  
Screening Tools ◽  
Nutritional Risk ◽  
Risk Screening ◽  
Nutritional Risk Index ◽  
Nrs 2002 ◽  
Cirrhotic Patients

AbstractMalnutrition risk screening in cirrhotic patients is crucial, as poor nutritional status negatively affects disease prognosis and survival. Given that a variety of malnutrition screening tools is usually used in routine clinical practice, the effectiveness of eight screening tools in detecting malnutrition risk in cirrhotic patients was sought. A total of 170 patients (57·1 % male, 59·4 (sd 10·5) years, 50·6 % decompensated ones) with cirrhosis of various aetiologies were enrolled. Nutritional screening was performed using the Malnutrition Universal Screening Tool, Nutritional Risk Index, Malnutrition Screening Tool, Nutritional Risk Screening (NRS-2002), Birmingham Nutritional Risk Score, Short Nutritional Assessment Questionnaire, Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Malnutrition diagnosis was defined using the Subjective Global Assessment (SGA). Data on 1-year survival were available for 145 patients. The prevalence of malnutrition risk varied according to the screening tools used, with a range of 13·5–54·1 %. RFH-NPT and LDUST were the most accurate in detecting malnutrition (AUC = 0·885 and 0·892, respectively) with a high sensitivity (97·4 and 94·9 %, respectively) and fair specificity (73·3 and 58 %, respectively). Malnutrition according to SGA was an independent prognostic factor of within 1-year mortality (relative risk was 2·17 (95 % CI 1·0, 4·7), P = 0·049) after adjustment for sex, age, disease aetiology and Model for End-stage Liver Disease score, whereas nutrition risk according to RFH-NPT, LDUST and NRS-2002 showed no association. RFH-NPT and LDUST were the only screening tools that proved to be accurate in detecting malnutrition in cirrhotic patients.

scholarly journals AN EVALUATION OF NUTRITIONAL INDEXES FOR TO PREDICTION THE HOSPITALIZATION DURATION IN ELDERLY CHRONIC KIDNEY DISEASE PATIENTS

2016 ◽  
pp. 1-4
Author(s):  
B. Buyukaydin ◽  
A.T. Isik ◽  
P. Soysal ◽  
M. Alay ◽  
R. Kazancioglu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Assessment ◽  
Short Form ◽  
Risk Index ◽  
Mini Nutritional Assessment ◽  
Nutritional Risk ◽  
Control Group ◽  
Dialysis Patients ◽  
Nutritional Risk Index

Objective: Chronic kidney disease and malnutrition are serious and frequently encountered co-morbidities among older patients. We evaluated nutritional status of older pre-dialysis patients and the effect of malnutrition on length of stay (LOS) in hospital. Materials and Methods: 65 years and over 33 hospitalized pre-dialysis patients with glomerular filtration rate between 10-30ml/min/1.73m2 were included. There is no control group. For all patients, biochemical analysis was performed. The malnutrition risk was evaluated with Mini Nutritional Assessment Short-Form (MNA-SF) and Geriatric Nutritional Risk Index (GNRI) and LOS in hospital was recorded. Results: Mean GNRI was 98.4±12.9 and the mean MNA-SF was 8±3.15. For all patients, mean LOS was 10.58±9 days. According to MNA-SF, malnourished patients’ LOS was longer and a difference was observed between MNA-SF and GNRI in terms of LOS prediction (p=0.005, p=0.230). Conclusion: For older pre-dialysis patients, MNA-SF is probably a more sensitive index in terms of LOS in hospital prediction.

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