Nutritional Risk Screening (NRS 2002) as a tool to predict clinical outcomes in hospitalized patients: a literature review

The presence of malnutrition in hospitalized patients is prevalent and studies show its association with a higher incidence of complications, mortality, length of stay, costs, and increased frequency of hospital readmission. Routine use of simple tracking procedures is recommended. Nutritional screening detects individuals who are malnourished or at risk of developing malnutrition, and who can receive specific nutritional support. Nutritional Risk Screening (NRS 2002) is a nutritional screening method recommended by the European Society for Clinical and Metabolism (ESPEN) and identifies the risk of developing malnutrition in hospitalized patients. The aim of this paper is to review the literature on the NRS screening method (2002) and its relationship with clinical outcomes in hospitalized patients.

The role of nutritional assessment for predicting Radiotherapy-induced adverse events in patients with gastric cancer

Objectives: The aim of this study was to investigate the role of nutritional factors in predicting radiotherapy-associated toxicities for gastric cancer patients. Methods: A total of 285 gastric cancer patients who underwent radiotherapy in our hospital between 2010 and 2017 were included in this retrospective study. Nutritional status assessment included body weight loss (BWL), body mass index (BMI), serum albumin, nutrition risk screening 2002(NRS-2002), patient-generated subjective global assessment(PG-SGA) and nutritional risk index (NRI). Results: Of all patients, 19.6% were underweight (BMI <18.5 kg/m2), 25.6% were hypoalbuminemia (<35 g l−1) and 48.8% lost ≥10% of body weight in the 6 month interval before radiotherapy(BWL). Meanwhile, 73.3%, 78.6 and 47.2% of the patients were diagnosed as malnutrition based on NRS-2002, PG-SGA and NRI, respectively. Hematological adverse events were present in 91.2% (≥Grade 1) and 20.4% (≥Grade 3) of the patients. Non-hematological adverse events occurred in 89.8% (≥Grade1) and 14.4% (≥Grade 3) of the patients. Multivariate analyses indicated that only hypoalbuminemia(<35 g l−1) was independent predictor for Grade 3/4 hematological and non-hematological adverse events. Meanwhile, higher BWL(≥10%) was also independent predictor for Grade 3/4 non-hematological adverse events. NRS-2002, PG-SGA and NRI score were not associated with treatment-induced adverse events. Conclusions: Body weight loss and serum albumin are useful factors for predicting severe adverse events in gastric cancer patients who undergo radiotherapy. Advances in knowledge: The use of nutritional factors in predicting severe adverse events enables implementation of individualized treatment strategies for early and intensive nutritional interventions in high-risk patients.

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 &lt;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 &lt;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 &lt;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.

Relationship between Nutritional Screening Tools and GLIM in Complicated IBD Requiring Surgery

Background: Accurate identification of malnutrition and preoperative nutritional care in Inflammatory Bowel Disease (IBD) surgery is mandatory. There is no validated nutritional screening tool for IBD patients. We developed a novel nutritional screening tool for IBD patients requiring surgery and compared it with other tools. Methods: we included 62 consecutive patients scheduled for elective surgery. The IBD Nutritional Screening tool (NS-IBD) was developed to screen patients for further comprehensive assessment. NRS-2002, MUST, MST, MIRT, SaskIBD-NR are compared with the new test. All screening tests were subsequently related to new GLIM criteria. Results: according to GLIM criteria, 25 (40%) IBD patients were malnourished (15 CD and 10 UC, 33% vs. 63%, p = 0.036). Stage 1 malnutrition was reported in ten patients, while stage 2 was detected in 15 patients. The comparison of each nutritional risk tool with GLIM criteria showed sensitivity of 0.52, 0.6, 0.6, 0.84, 0.84 and 0.92 for SASKIBD-NR, MUST, MST, NRS-2002, MIRT, and the new NS-IBD, respectively. Conclusions: in IBD, currently adopted nutritional screening tools are characterized by a low sensitivity when malnutrition diagnosis is performed with recent GLIM criteria. Our proposed tool to detect malnutrition performed the best in detecting patients that may require nutritional assessment and preoperative intervention.

Associations between Nutritional and Immune Status and Clinicopathologic Factors in Patients with Pancreatic Cancer: A Comprehensive Analysis

The aim of this study was to assess and analyze the nutritional status (NS) and immune status of pancreatic cancer (PC) patients. The retrospective analysis included 80 PC patients undergoing curative pancreatic resection in the Department of Digestive Tract Surgery of the Medical University (Katowice, Poland). Patients were divided by the tumor location (proximal vs. distal), age (≤65 years vs. >65 years), Nutritional Risk Score 2002 (NRS 2002) (<3 vs. ≥3), prognostic nutritional index (PNI) (<45 vs. ≥45), and the presence of postoperative complications (no-complication vs. complication) as well as the use of neoadjuvant chemotherapy (no neoadjuvant chemotherapy vs. neoadjuvant chemotherapy) into two subgroups, which were compared. Significantly higher weight loss was related to the proximal tumor location (p = 0.0104). Significantly lower serum total protein (p = 0.0447), albumin (p = 0.0468), hemoglobin (p = 0.0265) levels, and PNI (p = 0.03) were reported in older patients. The higher nutritional risk according to NRS 2002 was significantly associated with higher age (p = 0.0187), higher weight loss (p < 0.01), lower body mass index (BMI) (p = 0.0293), lower total lymphocyte count (p = 0.0292), longer duration of hospitalization (p = 0.020), neoadjuvant chemotherapy (p < 0.01), and preoperative biliary drainage (p = 0.0492). The lower PNI was significantly associated with higher weight loss (p = 0.0407), lower serum total protein and albumin concentration, lymphocyte count (p < 0.01) and higher neutrophil/lymphocyte (NLR), monocyte/lymphocyte (MLR), platelet/lymphocyte (PLR) ratios, and duration of hospitalization (p < 0.01). In the multiple logistic regression analysis, BMI ≥ 30 kg/m2 (OR: 8.62; 95%CI: 1.24–60.04; p = 0.029521) and NRS 2002 ≥ 3 (OR: 2.87; 95%CI: 0.88–9.33; p = 0.048818) predicted postoperative complications. In the multiple linear regression analysis, the higher NRS 2002 score was linked with the longer duration of hospitalization (b = 7.67948; p = 0.043816), and longer duration of postoperative hospitalization was associated with a higher complication rate (b = 0.273183; p = 0.003100). Nutritional impairment correlates with a systemic inflammatory response in PC patients. Obesity (BMI ≥ 30 kg/m2) and malnutrition (NRS 2002 ≥ 3) predict postoperative complications, which are associate with a longer hospital stay. Assessment of nutritional and immune status using basic diagnostic tools and PNI and immune ratio (NLR, MLR, PLR) calculation should be the standard management of PC patients before surgery to improve the postoperative outcome.

PERFIL DOS USUÁRIOS DE TERAPIA NUTRICIONAL PARENTERAL EM HOSPITAIS NO CENÁRIO BRASILEIRO: UMA REVISÃO SISTEMÁTICA DE LITERATURA

A Terapia Nutricional são procedimentos terapêuticos realizados nos pacientes incapazes de satisfazer adequadamente suas necessidades nutricionais e metabólicas por via oral. Esse conjunto de procedimentos visa à manutenção ou recuperação do paciente em estado nutricional por meio da Nutrição Parenteral (NP) ou Enteral (NE). Investigar o perfil dos pacientes submetidos à Terapia Nutricional Parenteral (TNP) em hospitais brasileiros. Trata-se de uma revisão sistemática realizada seguindo as recomendações PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Realizou-se busca para seleção dos estudos em cinco bases de dados: Literatura Latino-Americana em Ciências da Saúde (LILACS), Scientific Electronic, Library Online (SciELO) e Medline, usando os descritores de busca: “Terapia Nutricional”, “Nutrição Parenteral” e “Brasil”, por meio dos operadores boleanos “and” e “or”. Os critérios de inclusão foram: artigos originais, relacionados ao tema de interesse desse estudo e publicados nos últimos cinco anos (2015-2020) nos idiomas português e inglês. Por meio da investigação nas bases de dados foram encontrados 57 artigos, desses foram selecionados 43 dos últimos 5 anos, dos quais 2 eram duplicados e 12 não atendiam aos critérios de inclusão estabelecidos à priori, resultando em 14 artigos. Verificou-se risco de desnutrição de acordo com NRS-2002 e alto risco de desnutrição de acordo com 'MUST' aumentaram os custos do paciente, respectivamente, em 21,1% e 28,8%. A terapia nutricional parenteral retrata uma parte importante dos custos no tratamento de indivíduos hospitalizados, principalmente nos casos de cânceres. De acordo com os dados analisados o custo com dieta parenteral foi maior no grupo de óbitos.

Relationship between the depression levels and nutritional statuses of advanced stage cancer patients

Objective This study aimed to determine the depression and nutritional statuses of advanced stage cancer patients and investigate the relationship between depression and malnutrition. Method The descriptive, cross-sectional, and correlational study was conducted with 245 patients with advanced cancer. The data were collected by using an Information Form, the Visual Analog Scale, the NRS-2002-Nutritional Risk Score, and the Beck Depression Inventory. Results The mean NRS-2002 score of the patients was 2.22, and when the cutoff value was accepted as 3, it was determined that 39.2% of the patients had malnutrition. The mean Beck Depression Inventory score of the patients was 35.06, and they were found to experience severe depression. There was a positive and significant relationship between the NRS-2002 scores and the Beck Depression Inventory scores (r = 0.409; p < 0.001). Significance of results These results showed that there was a strong relationship between the depression and malnutrition levels of advanced stage cancer patients. Deterioration in the nutritional status of the advanced stage cancer patients was associated with a significant worsening effect in terms of depression and pain.