Nutritional risk and six-year mortality in adult patients admitted to a referral hospital: A cohort study.

The modified NUTRIC score can be used for nutritional risk assessment as well as prognosis prediction in critically ill COVID-19 patients.

Efficiency of a technology-assisted nutritional screening system: A retrospective analysis of 11,722 admissions in a tertiary hospital

Nutrition risk is prevalent in intensive care unit (ICU) settings and related to poor prognoses. We aimed to evaluate the concurrent and predictive validity of different nutrition risk screening tools in the ICU. Data were collected between 2019 and 2022 in six ICUs (n = 450). Nutrition risk was evaluated by modified Nutrition Risk in Critically ill (mNUTRIC), Nutritional Risk Screening (NRS-2002), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), and Nutritional Risk in Emergency (NRE-2017). Accuracy and agreement of the tools were assessed; logistic regression was used to verify the association between nutrition risk and prolonged ICU stay; Cox regression was used for mortality in the ICU, both with adjustment for confounders. NRS-2002 ≥5 showed the best accuracy (0.63 [95% CI, 0.58-0.69]) with mNUTRIC, and MST with NRS-2002 ≥5 (0.76 [95% CI, 0.71-0.80]). All tools had a poor/fair agreement with mNUTRIC (k = 0.019-0.268) and moderate agreement with NRS-2002 ≥5 (k = 0.474-0.503). MUST (2.26 [95% CI 1.40-3.63]) and MST (1.69 [95% CI, 1.09-2.60]) predicted death in the ICU, and the NRS-2002 ≥5 (1.56 [95% CI 1.02-2.40]) and mNUTRIC (1.86 [95% CI, 1.26-2.76]) predicted prolonged ICU stay. No nutrition risk screening tool demonstrated a satisfactory concurrent validity; only the MUST and MST predicted ICU mortality and the NRS-2002 ≥5 and mNUTRIC predicted prolonged ICU stay, suggesting that it could be appropriate to adopt the ESPEN recommendation to assess nutrition status in patients with ≥48 h in the ICU.

To compare nutritional risk in adult patients undergoing chemotherapy and radiotherapy in the beginning, middle, and end of oncologic treatment. This prospective, comparative study included 83 adult patients, 44 undergoing chemotherapy (CT group) and 39 undergoing radiotherapy (RT group) at an oncology treatment center. Nutritional risk was determined by NRS-2002 in the beginning, middle, and end of therapy. Statistical analysis was performed using Statistica 8.0 software. No differences in food intake or body mass index were observed between the CT (24.6±4.8 kg/m²) and RT groups (25.0±5.9 kg/m², p=0.75). Weight loss in the preceding 3 months was detected in 56.8% of CT group and 38.5% of RT group (p=0.09). The weight loss percentage compared with the usual weight within 3 months was greater (p<0.001) in the CT (11.4±6.5%) than in the RT group (3.9±6.8%). In the beginning of treatment, we observed high percentages of patients at moderate (18.2 vs. 15.4%, p=0.73) and high nutritional risk (61.4 vs. 48.7%, p=0.25), with no statistical difference between the CT and RT groups, respectively. During therapy, the nutritional risk remained unaltered in both groups. In the end of therapy, the majority of patients were at moderate (18.2 vs. 12.8%, p=0.50) or severe nutritional risk (50.0 vs. 51.3%, p=0.91), in the CT and RT groups, respectively, regardless of the type of oncologic treatment. The high prevalence of patients at moderate or high nutritional risk in the beginning of treatment indicates the need for an early and continuous follow-up of the nutritional status of patients undergoing oncologic treatment.

Purpose: This study aimed to associate nutritional and sarcopenia risk with clinical outcomes in elderly patients with COVID-19. Methods: This is a longitudinal retrospective cohort study. Hospitalized elderly individuals diagnosed with COVID-19 were included in the study. Nutritional risk was assessed using the Malnutrition Universal Screening Tool (MUST), and Sarcopenia risk was assessed using the SARC-F. Associations were assessed throughmultivariable logistic models. Results: In total, 127 patients (mean age: 71.25 ±8.06 years) were followed up until the clinical outcome. Sarcopenia risk was diagnosed in 63.8% of the sample, whereas nutritional risk was observed in 72%. Hospitalization in the intensive care unit (ICU) was required in 48.8% of the sample, 38.6% required mechanicalventilation, and 32.3% died. Elderly individuals with sarcopenia risk were more likely to be hospitalized inICUs (OR: 5.62; 95%CI: 2.2-14.3), require mechanical ventilation (OR: 4.0; 95% CI: 1.5-10.2), and die (OR: 5.06; 95% CI: 1.7-14.2). The risk of malnutrition assessed through MUST was an important risk factor for death (OR = 30.15; 95% CI: 3.6-245.8; p&lt;0.01). Conclusion: Sarcopenia risk was a risk factor for death, hospitalization in ICU, and mechanical ventilation, while nutritional risk was a risk factor for death.

Twenty years ago, ESPEN published its "Guidelines for nutritional screening 2002", with the note that these guidelines were based on the evidence available until 2002, and that they needed to be updated and adapted to current state of knowledge in the future. Twenty years have passed, and tremendous progress has been made in the field of malnutrition risk screening. Many screening tools have been developed and validated for different patient groups and different health care settings. Some countries even have introduced mandatory screening for malnutrition at admission to hospital. Yet, changes in society and healthcare require a reflection on current practice and policies regarding malnutrition risk screening. In this opinion paper, we share our perspectives on malnutrition risk screening in the twenty-twenties, addressing the changing and varying profile of the malnourished individual, the goals of screening and screening tools (i.e., preventive or reactive), the construct of malnutrition risk (i.e., screening for risk factors or screening for existing malnutrition), and screening alongside a patient's journey.

Clinical and Laboratory Predictors of 30-Day Hospital Readmission Risk in Adult Patients with Sickle Cell Disease

Objetivo: Verificar a capacidade de identificação de risco nutricional pelo Malnutrition Screening Tool em comparação à Miniavaliação nutricional em idosos e identificar a prevalência de risco nutricional e desnutrição no público avaliado. Metodologia: Estudo transversal, analítico, com triagem e avaliação nutricional dos pacientes idosos (&gt;=60 anos) hospitalizados, através dos métodos Malnutrition Screening Tool e Miniavaliação nutricional. Resultados: Foram avaliados 106 pacientes, com 48,1% apresentando risco nutricional e 22,6% apresentando desnutrição segundo a Miniavaliação nutricional. Pelo Malnutrition Screening Tool, encontrou-se risco nutricional em 52,8% dos pacientes nas primeiras 48 horas de internação. Em relação à capacidade do Malnutrition Screening Tool em identificar risco nutricional nos pacientes idosos, em comparação com a Miniavaliação nutricional, observou-se associação entre os testes (p&lt;0,02), porém com tendência a um falso negativo, pois 19,8% dos pacientes classificados como sem risco nutricional pela Malnutrition Screening Tool apresentaram risco nutricional pela Miniavaliação nutricional. Conclusões: A utilização dos dois métodos se confirma para aqueles com risco nutricional, não podendo ser estendida para os sem risco nutricional pela divergência entre as análises, podendo ter o falso negativo nas avaliações da escala Malnutrition Screening Tool.

To investigate malnutrition prevalence on presentation to a Medical Assessment and Planning Unit (MAPU) in a setting designed to prevent hospital admission, the association of nutritional status with hospital readmission at 90 days, and agreement of nutritional risk between the Malnutrition Screening Tool (MST) and Subjective Global Assessment (SGA). Prospective longitudinal cohort study of consecutive patients admitted to MAPU during the first 6 weeks of operation. The main outcome measures were prevalence of malnutrition and hospital readmission at 90 days. Sensitivity and specificity of the MST was assessed against the criterion standard of SGA. The mean participant age was 62 years (n = 153, s.d. 17.4 years) with 50% male (77/153, 95% CI 42-58%). According to the SGA, 17% (95% CI 8-26%) were assessed as malnourished on admission. The MST identified that 18% (95% CI 12-24%) were at nutritional risk, and participants screening positive for nutritional risk had significantly increased odds of hospital readmission at 90 days (OR 3.4, 95% CI, 1.3-9.1, P < 0.029). The MST was practical and successfully identified patients assessed as malnourished within the MAPU setting (sensitivity 73%, specificity 76%, negative predictive value 93%, positive predictive value 38%). Malnutrition is a significant problem in a MAPU setting, and patients screened at nutritional risk are at significantly higher risk of hospital readmission within 90 days.

Malnutrition is a prevalent issue in critically ill elderly patients and is closely linked to poor clinical outcomes. This study aimed to assess the prognostic value of four nutritional indices-modified nutrition risk in the critically ill (mNUTRIC), Geriatric Nutritional Risk Index (GNRI), hemoglobin, albumin, lymphocyte, and platelet (HALP), and neutrophil-to-lymphocyte ratio (NLR)-in predicting intensive care unit (ICU) outcomes. This prospective cohort study included elderly patients (aged ≥ 65 years) who were admitted to the medical ICU of a tertiary care university hospital. Nutritional indices (mNUTRIC, GNRI, HALP, and NLR) were evaluated for their prognostic value in predicting 28-day mortality, ICU mortality, and ICU length of stay (LOS) using multivariable regression and receiver operating characteristic (ROC) curve analyses. Seventy-three patients were included, with a median age (interquartile range) of 74 (10) years and 56.2% male. The mNUTRIC score was identified as an independent risk factor for 28-day mortality (OR = 2.505, 95%CI: 1.164-5.391, p = 0.019) and ICU mortality (OR = 2.736, 95%CI: 1.350-5.545, p = 0.005), with strong predictive performance (AUC: 0.864 and 0.858, respectively). It was also associated with prolonged ICU LOS (RR = 1.117, 95% CI: 1.033-1.207, p = 0.005). While GNRI exhibited good predictive performance (AUC: 0.811 and 0.799 for 28-day mortality and ICU mortality, respectively), it was not an independent factor. In contrast, HALP and NLR showed limited prognostic value for mortality. The mNUTRIC score was identified as the strongest prognostic tool, with GNRI also demonstrating considerable predictive value for mortality outcomes, enhancing nutritional risk screening and clinical decision-making in elderly ICU patients.

Malnutrition screening tool and malnutrition universal screening tool as a predictors of prolonged hospital stay and hospital mortality: A cohort study

Introduction: Various scoring systems (modified Nutrition Risk in Critically ill, Nutritional Risk Screening 2002, Nutritional Risk Index, Geriatric Nutritional Risk Index, and Malnutrition Universal Screening Tool) are used to evaluate nutrition in patients admitted to the intensive care unit. This study examined the relationship between 5 screening scores and mortality on day 1 of intensive care unit admission. Materials and Method: This observational, prospective study was approved by the local Ethics Committee (FSMEAH-KAEK-2021/60).Data from 103 patients, hospitalized in the intensive care unit&gt; 24 h between June 1 and September 30, 2021, were included. Informed consent was provided by their relatives, and 5 different nutrition scores were recorded on day 1 of intensive care unit hospitalization. Correlations between mortality and scores were examined, and mechanical ventilation and intensive care unit hospitalization days were compared between low- and high-risk patients in both score groups Results: According to the modified Nutrition Risk in Critically ill score, mortality rate, intensive care unit length of stay, and duration of mechanical ventilation were significantly higher among high-risk patients than those in low-risk patients. As risk increased with the Malnutrition Universal Screening Tool score, an increase in mortality was observed. The area under the receiver operating characteristic curves for mortality were greatest for the modified Nutrition Risk in Critically ill score and Nutritional Risk Index scores. Conclusion: The modified Nutrition Risk in Critically ill and Nutritional Risk Index scores were the most effective predictors of mortality among geriatric patients admitted to the intensive care unit and may be used according to clinician preference. Keywords: Geriatrics; Intensive Care Unit; Mortality; Nutrition Assessment.

275 Background: The provision of adequate nutritional care in outpatient cancer centers was the focus of a 2016 NAS Workshop, “Assessing Nutrition Care in Outpatient Oncology.” Here we report our internal project evaluating ongoing documentation of a malnutrition screening tool (MST) at 3 national cancer centers (CC). Methods: Screening scores from a validated 2 question MST scale were entered into the EMR. Questions probe for: 1) unintentional weight loss; and 2) eating poorly because of a decreased appetite. A score of ≥ 2 indicated nutrition risk. De-identified oncology clinic visit data were examined monthly to assess MST utilization and scores for radiation and medical oncology patients across the CC’s. Results: Approximately two-thirds (67%) of unique medical oncology patients that visited the CC’s had documented MST data with 9% (n = 144,129) scoring at nutritional risk. MST completion rates were higher in radiation oncology clinics secondary to staff education. Of those that had a valid MST score in radiation clinics, 13% (n = 23,202) of MST scores indicated nutritional risk. Conclusions: The MST is a valid malnutrition screening tool for outpatient oncology patients, yet this tool is not uniformly being utilized nationally. Consistent use of the MST in the electronic medical record and leveraging data on utilization are needed to inform staff compliance, consistency in care, future dietitian staffing patterns, cost/benefit analysis, and health outcomes for oncology patients. [Table: see text][Table: see text]

The emergency department (ED) is the most frequent access route to the hospital. Nutrition risk (NR) screening allows the early identification of patients at risk of malnutrition. This study aimed to evaluate the feasibility and predictive validity of five different tools in EDs: Nutritional Risk Screening 2002 (NRS-2002), Nutritional Risk Emergency 2017 (NRE-2017), Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT), Malnutrition Universal Screening (MUST), and Malnutrition Screening Tool (MST). Patients with scores ≥3 according to the NRS-2002, ≥1.5 according to the NRE-2017, and ≥2 according to the MUST, RFH-NPT, or MST were classified with NR. Prolonged length of stay (LOS) and 1-year mortality were evaluated. 431 patients were evaluated (57.31 ± 15.6 years of age; 54.4% women) in a public hospital in southern Brazil. The prevalence of NR was: 35% according to the NRS-2002, 43% according to the MST, 45% according to the NRE-2017 and MUST, and 49% according to the RFH-NPT. Patients with NR, had a greater risk of prolonged LOS (P < 0.001). The presence of NR was associated with an increased risk of 1-year mortality according to the NRS-2002 (hazard ratio [HR]: 4.04; 95% CI, 2.513-6.503), MST (HR: 2.60; 95% CI, 1.701-3.996), NRE-2017 (HR: 4.82; 95% CI, 2.753-8.443), MUST (HR: 4.00; 95% CI, 2.385-6.710), and RFH-NPT (HR: 5.43; 95% CI, 2.984-9.907). NRE-2017 does not require objective data and presented predictive validity for all outcomes assessed, regardless of the severity of the disease, and thus appears to be the most appropriate tool for carrying out NR screening in the ED.

Comparison of tools for nutritional assessment and screening at hospital admission: A population study