Nutritional Risk Group Research Articles

P09.11 Nutritional Risk Status Predicts Overall Survival of Mexican Patients with Advanced Non-Small-Cell Lung Cancer (NSCLC)

The nutritional status has been a useful predictor of survival in various cancers. However, the utility of a new nutritional screening tool specifically for oncology patients (NUTRISCORE) to detect nutritional risk for malnutrition in patients with advanced non-small cell lung cancer has not been examined. The aim of this study was to assess nutritional risk for malnutrition status estimated by NUTRISCORE as prognostic factor in Mexican patients with advanced non-small cell lung cancer. We evaluated 126 patients with advanced lung cancer (IIIB and IV). Demographic and clinical data were collected. Nutritional risk status was estimated by NUTRISCORE at diagnosis in routine screening evaluation before systemic treatment and divided into risk and no risk groups. Kaplan-Meier survival analysis and the log-rank test were used to calculate OS. Univariate and multivariate analysis to identify variables associated with OS was assessed using Cox regression model. A total of 126 elderly advanced lung cancer patients were included between 2013 and 2018. Among the included patients, the median age was 63.39 (range: 29-86 years), and 62 (49.2 %) patients were females and 64 (50.8 %) were males. Seventy one (56.3%) and 56(43.7%) patients were assigned to nutritional risk group and no risk group, respectively. Median overall survival (OS) was worse in the nutritional risk (risk vs no risk, 12.6 vs 46.6 months; p 0.000). In multivariate analysis, nutritional risk involuntary weight loss (p=0.020), and decreased appetite (p=0.001) were independent prognostic factors for OS. The assessment of NUTRISCORE risk could assist the identification of patients with advanced lung cancer with poor prognosis and a factor to attend in and probe in clinical trials.

Clinical application of the modified pediatric nutritional risk screening tool

OBJECTIVE To study the clinical application of the modified nutritional risk screening tool and nutrition assessment in pediatric patients in China, and to provide a theoretical basis for establishing a standardized nutritional management process for pediatric patients. METHODS A retrospective analysis was performed for the nutritional risk screening and nutrition assessment data of 16 249 hospitalized children. According to the degree of nutritional risk, the children were divided into a high nutritional risk group with 588 children, a moderate nutritional risk group with 4 330 children, and a non-nutritional risk group with 11 331 children. Nutrition assessment results were compared between groups. The composition of nutritional risk screening scores and the impact of nutritional risk screening on the rate of nutrition support therapy were analyzed. RESULTS The incidence rate of nutritional risk was 30.27% (4 918/16 249), and the incidence rates of malnutrition and overnutrition were 27.37% (4 448/16 249) and 11.29% (1 834/16 249), respectively. Nutrition assessment results were significantly correlated with nutritional risk (≥ 5 years old:rs=0.313, P < 0.05; < 5 years old:rs=-0.304, P < 0.05). There was a significant difference in the composition of scoring items between the groups with different nutritional risks (P < 0.05). With the implementation of nutritional risk screening, there was a gradual increase in the rate of nutrition support therapy year by year (P < 0.05). CONCLUSIONS There is a high incidence rate of nutritional risk in hospitalized children. The use of the modified pediatric nutritional risk screening tool can promote the implementation of standardized nutritional management.

Nutrition risk profile of 62 408 inpatients based on electronic health records in a tertiary children's hospital

ObjectivesThis study aimed to evaluate the nutrition risk profile of hospitalized children with electronic health record–based nutrition risk screening. Additionally, this study analyzed the association between high nutrition risk and clinical outcomes. MethodsChildren discharged from Shanghai Children's Medical Center between 2017 and 2018 were enrolled and nutritionally screened. Nutrition risk scores using the Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP), length of stay (LOS), and costs of hospitalization were recorded. Enrolled patients were categorized into two groups: the low and medium nutrition risk (LMNR) group, with scores ranging from 0 to 3, and the high nutrition risk (HNR) group, with scores ≥4. ResultsOut of 62 408 subjects, 17.4% were at HNR. Patients with congenital heart diseases (83.9%), hematology-oncology diseases (26.0%) and gastroenterological diseases (21.4%) were affected most. Infants had the highest HNR rates (35.5%) of any age group. Surgical patients (20.7%) had a higher rate of HNR than non-surgical patients (9.5%). The HNR group had longer LOS (10.0 d versus 3.0 d, P < 0.001), higher total hospital costs (53 680.1 Chinese yuan [CNY] versus 8810.1 CNY, P < 0.001), and higher costs of antibiotics (441.0 CNY versus 0.0 CNY, P < 0.001) compared to the LMNR group. As STAMP score values increased, growing LOS and costs of hospitalization, medications, and antibiotics were observed. ConclusionsA high prevalence of HNR was found in patients of Shanghai Children's Medical Center. Surgeries, specific disease, and infancy were important HNR risk factors. HNR scores using STAMP might predict prolonged LOS and higher medical costs.

Geriatric nutritional risk index in screening malnutrition among young adult and elderly trauma patients

Background: The geriatric nutritional risk index (GNRI) calculated as 1.489 × albumin (g/dL) +41.7× (current body weight/ideal body weight) is useful in identifying high-risk for malnutrition in elderly patients with subacute or chronic diseases. Given that trauma patients have sustained injuries in an acute condition, this study is designed to explore the association between GNRI on admission and outcomes in elderly and young adult patients with trauma. Materials and Methods: From January 01, 2009, to December 31, 2019, a total of 1772 elderly and 2194 young adult trauma patients were categorized into four nutritional risk groups according to GNRI: high-risk group (GNRI 98). Propensity score-matched patient cohorts were created in different nutritional risk groups against the no-risk group to minimize the confounding effects of sex, age, pre-existing comorbidities, Glasgow Coma Scale score, and Injury Severity Score on outcome measurements. Primary outcome was in-hospital mortality, and secondary outcome was the length of hospital stay. Results: Young adult patients with trauma were comparable in pattern of mortality outcomes and hospital stays to that in elderly patients. Analysis of the selected propensity score-matched patient cohorts revealed that both elderly and young adult patients in the high-risk group had significantly higher odds of mortality (elderly, odds ratio [OR], 6.5; 95% confidence interval [CI], 3.00-14.03; P Conclusion: This study demonstrated that the GNRI could serve as a useful screening method to identify high-risk malnutrition in acutely injured trauma patients, including not only the elderly trauma patients but also the young adult trauma patients.

Association between Geriatric Nutritional Risk Index and Mortality in Older Trauma Patients in the Intensive Care Unit.

The geriatric nutritional risk index (GNRI) is a simple and efficient tool to assess the nutritional status of patients with malignancies or after surgery. Because trauma patients constitute a specific population that generally acquires accidental and acute injury, this study aimed to identify the association between the GNRI at admission and mortality outcomes of older trauma patients in the intensive care unit (ICU). Methods: The study population included 700 older trauma patients admitted to the ICU between 1 January 2009 and 31 December 2019. The collected data included age, sex, body mass index (BMI), albumin level at admission, preexisting comorbidities, injury severity score (ISS), and in-hospital mortality. Multivariate logistic regression analysis was conducted to identify the independent effects of univariate predictive variables resulting in mortality in our study population. The study population was categorized into four nutritional risk groups: a major-risk group (GNRI < 82; n = 128), moderate-risk group (GNRI 82 to <92; n = 191), low-risk group (GNRI 92–98; n = 136), and no-risk group (GNRI > 98; n = 245). Results: There was no significant difference in sex predominance, age, and BMI between the mortality (n = 125) and survival (n = 575) groups. The GNRI was significantly lower in the mortality group than in the survival group (89.8 ± 12.9 vs. 94.2 ± 12.0, p < 0.001). Multivariate logistic regression analysis showed that the GNRI (odds ratio—OR, 0.97; 95% confidence interval (CI) 0.95–0.99; p = 0.001), preexisting end-stage renal disease (OR, 3.6; 95% CI, 1.70–7.67; p = 0.001), and ISS (OR, 1.1; 95% CI, 1.05–1.10; p < 0.001) were significant independent risk factors for mortality. Compared to the patients in group of GNRI > 98, those patients in group of GNRI < 82 presented a significantly higher mortality rate (26.6% vs. 13.1%; p < 0.001) and length of stay in hospital (26.5 days vs. 20.9 days; p = 0.016). Conclusions: This study demonstrated that GNRI is a significant independent risk factor and a promising simple screening tool to identify the subjects with malnutrition associated with higher risk for mortality in those ICU elderly trauma patients.

Geriatric Nutritional Risk Index as a Tool to Evaluate Impact of Malnutrition Risk on Mortality in Adult Patients with Polytrauma

Background: Identification of malnutrition is especially important in severely injured patients, in whom hypermetabolism and protein catabolism following traumatic injury worsen their nutritional condition. The geriatric nutritional risk index (GNRI), based on serum albumin level and the current body weight/ideal body weight ratio, is useful for identifying patients with malnutrition in many clinical conditions. This study aimed to explore the association between admission GNRI and mortality outcomes of adult patients with polytrauma. Methods: From 1 January 2009 to 31 December 2019, a total of 348 adult patients with polytrauma, registered in the trauma database of a level I trauma center, were recognized and categorized into groups of death (n = 71) or survival (n = 277) and into four nutritional risk groups: a high-risk group (GNRI < 82, n = 87), a moderate-risk group (GNRI 82 to <92, n = 144), a low-risk group (GNRI 92–98, n = 59), and a no-risk group (GNRI > 98, n = 58). Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for mortality. The mortality outcomes of patients at various nutritional risks were compared to those of patients in the no-risk group. Results: The comparison between the death group (n = 71) and the survival group (n = 277) revealed that there was no significant difference in gender predominance, age, pre-existing comorbidities, injury mechanism, systolic blood pressure, and respiratory rate upon arrival at the emergency room. A significantly lower GNRI and Glasgow Coma Scale score but higher injury severity score (ISS) was observed in the death group than in the survival group. Multivariate logistic regression analysis revealed that Glasgow Coma Scale (GCS), odds ratio (OR), 0.88; 95% confidence interval (CI), 0.83–0.95; p < 0.001), ISS (OR, 1.07; 95% CI, 1.04–1.11; p < 0.001), and GNRI (OR, 0.94; 95% CI, 0.91–0.97; p < 0.001) were significant independent risk factors for mortality in these patients. The mortality rates for the high-risk, moderate-risk, low-risk, and no-risk groups were 34.5%, 20.1%, 8.5%, and 12.1%, respectively. Unlike patients in the moderate-risk and low-risk groups, patients in the high-risk group had a significantly higher death rate than that of those in the no-risk group. Conclusions: This study revealed that the GNRI may serve as a simple, promising screening tool to identify the high risk of malnutrition for mortality in adult patients with polytrauma.

Geriatric Nutritional Risk Index as a Screening Tool to Identify Patients with Malnutrition at a High Risk of In-Hospital Mortality among Elderly Patients with Femoral Fractures-A Retrospective Study in a Level I Trauma Center.

Background: Malnutrition is frequently underdiagnosed in geriatric patients and is considered to be a contributing factor for worse outcomes during hospitalization. In addition, elderly patients who undergo trauma are often malnourished at the time of incurring fractures. The geriatric nutritional risk index (GNRI), calculated based on the serum albumin level and the ratio of present body weight to ideal body weight, was proposed for the assessment of the nutritional status of elderly patients with various illnesses. This study aimed to investigate whether the GNRI has a prognostic value that links the nutritional status and mortality outcomes of elderly patients who have previously undergone trauma with femoral fractures. Methods: From January 1, 2009 to December 31, 2019, a total of 678 elderly patients with femoral fractures were categorized into four nutritional risk groups: a major-risk group (GNRI < 82; group 1, n = 127), moderate-risk group (GNRI 82–92; group 2, n = 179), low-risk group (GNRI 92–98; group 3, n = 123), and no-risk group (GNRI > 98; group 4, n = 249). To minimize the confounding effects of sex, age, preexisting comorbidities, and injury severity of patients on outcome measurements, propensity score-matched patient cohorts were created to assess the impact of patients being in different nutritional risk groups on the in-hospital mortality outcomes against the no-risk group. Results: The patients in groups 1–3 were significantly older and presented a significantly lower body mass index and lower serum albumin levels than those in group 4. Compared with patients in group 4 (3.6%), a significantly higher mortality rate was found in the patients in group 1 (17.3%, p < 0.001), but not in those in group 2 (6.7%) or group 3 (2.4%). The study of propensity score-matched patient cohorts provided similar results; group 1 patients had significantly higher odds of mortality than group 4 patients (odds ratio, 6.3; 95% confidence interval, 1.34–29.37; p = 0.009), but there were no significant differences in mortality risks among patients in groups 2 and 3 compared with those in group 4. Conclusions: This preliminary study suggested that the GNRI may be used as a screening tool to identify patients with malnutrition at a high risk of mortality among elderly patients with femoral fractures. A prospective study is needed to validate the suggestion.

Evaluation of Malnutrition Risk in Lung Transplant Candidates Using the Nutritional Risk Index.

Malnutrition in lung transplant (LTx) candidates is an important risk factor for adverse outcomes. We sought to evaluate the Nutritional Risk Index (NRI) in LTx candidates, a validated measure of malnutrition risk in chronic disease. We aimed to characterize malnutrition risk using NRI, evaluate change in body weight between nutritional risk groups, and assess association of malnutrition risk with pretransplant and posttransplant outcomes. Retrospective, single-center cohort study of LTx candidates (2014-2015) evaluated by a dietitian before listing. Nutritional parameters, weight change pretransplant and posttransplant, and clinical outcomes were abstracted up to 1-year posttransplant. NRI was calculated as follows: (1.519 × albumin) + (41.7 × current weight/ideal weight) with high malnutrition risk defined as the lowest quartile of NRI for cystic fibrosis (CF) and non-CF patients. The cohort comprises 247 LTx candidates (57% male; median age 59 y; non-CF 88%). Non-CF candidates had a greater mean NRI compared with CF patients (109 ± 11 versus 95 ± 12; P < 0.0001). 86% with high malnutrition risk maintained/gained weight (≥5%) pretransplant. In 196 LTx recipients, malnutrition risk was not associated with hospital stay, discharge disposition, or 1-year mortality. The median percent weight gain for LTx recipients in the first year was 10.5% (4.0-20.1), with high malnutrition risk recipients having comparable or greater weight gain to the low-risk group (mean difference for non CF: 6.8%; P = 0.02 and CF: -3.8%; P = 0.65). Malnutrition risk assessed with NRI was not prognostic of posttransplant outcomes in this retrospective cohort. LTx candidates with high malnutrition risk were able to maintain their weight pretransplant and demonstrated considerable weight gain in the first-year posttransplant.

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

Background & aimsIn the newly emerged Coronavirus Disease 2019 (COVID-19) disaster, little is known about the nutritional risks for critically ill patients. It is also unknown whether the modified Nutrition Risk in the Critically ill (mNUTRIC) score is applicable for nutritional risk assessment in intensive care unit (ICU) COVID-19 patients. We set out to investigate the applicability of the mNUTRIC score for assessing nutritional risks and predicting outcomes for these critically ill COVID-19 patients.MethodsThis retrospective observational study was conducted in three ICUs which had been specially established and equipped for COVID-19 in Wuhan, China. The study population was critically ill COVID-19 patients who had been admitted to these ICUs between January 28 and February 21, 2020. Exclusion criteria were as follows: 1) patients of ＜18 years; 2) patients who were pregnant; 3) length of ICU stay of ＜24 h; 4) insufficient medical information available. Patients' characteristics and clinical information were obtained from electronic medical and nursing records. The nutritional risk for each patient was assessed at their ICU admission using the mNUTRIC score. A score of ≥5 indicated high nutritional risk. Mortality was calculated according to patients’ outcomes following 28 days of hospitalization in ICU.ResultsA total of 136 critically ill COVID-19 patients with a median age of 69 years (IQR: 57–77), 86 (63%) males and 50 (37%) females, were included in the study. Based on the mNUTRIC score at ICU admission, a high nutritional risk (≥5 points) was observed in 61% of the critically ill COVID-19 patients, while a low nutritional risk (<5 points) was observed in 39%. The mortality of ICU 28-day was significantly higher in the high nutritional risk group than in the low nutritional risk group (87% vs 49%, P ＜0.001). Patients in the high nutritional risk group exhibited significantly higher incidences of acute respiratory distress syndrome, acute myocardial injury, secondary infection, shock and use of vasopressors. Additionally, use of a multivariate Cox analysis showed that patients with high nutritional risk had a higher probability of death at ICU 28-day than those with low nutritional risk (adjusted HR = 2.01, 95% CI: 1.22–3.32, P = 0.006).ConclusionsA large proportion of critically ill COVID-19 patients had a high nutritional risk, as revealed by their mNUTRIC score. Patients with high nutritional risk at ICU admission exhibited significantly higher mortality of ICU 28-day, as well as twice the probability of death at ICU 28-day than those with low nutritional risk. Therefore, the mNUTRIC score may be an appropriate tool for nutritional risk assessment and prognosis prediction for critically ill COVID-19 patients.

O impacto do envelhecimento no paciente hospitalizado: análise do risco nutricional

Objective: The purpose of this study was to analyze the presence of nutritional risk and their correlation with clinical outcome in elderly hospitalized patients. Methods: The study variables were weight, height, body mass index (BMI), nutritional risk, length of stay and death of hospitalized patients in a public hospital in São Paulo. These data were obtained by Sheet Nutritional Care, dietitians completed by the institution. Nutritional risk was determined by nutritional screening tool NRS-2002. To investigate the association between the presence of nutritional risk and other study variables, we used Rao &amp; Scott test and multiple logistic regression (stepwise forward), with 5% significance level. It proceeded to univariate analysis, and variables with p &lt;0.20, in ascending order of entry were included in multiple regression. They remained in the model the variables with p &lt;0.05, or those set by at least 10% the value of odds ratio of other variables. Results: We evaluated the records of 2613 patients, with a mean age of 73.87 years, 54.84% female, 47.26% of the population were at nutritional risk and 37.3% undernutrition. The nutritional risk groups according to age showed that the greater the age, the prevalence greater risk for malnutrition. There was a good statistical correlation with BMI, because the risk was more prevalent in malnourished group (54.41%). It was found that 11.9% of those who had died nutritional risk, while those who did not risk, only 1.66%. Conclusion: From this study it was found that for older people studied the risk for malnutrition correlated positively with age, BMI, length of stay and the occurrence of deaths.

Associations between Nutritional Risk and Mental Health in an Elderly Korean Population

Objective：Older adults are at greater risk for malnutrition than younger adults, and malnutrition can be associated with a variety of mental problems. This study was undertaken to investigate differences in mental health indicators according to nutritional risk administered to elderly people living in the community. Methods：Nutritional risk score was assessed using the ‘Determine Your Nutrition Health’ checklist, developed by the Nutritional Screening Initiative. The study enrolled 400 elderly people living in the community. Study subjects were divided into 3 groups based on their nutritional risk score: good nutrition (score ≤2; n=275), moderate nutritional risk (score 3-5; n=63), and high nutritional risk (score ≥6; n=62). The General Health Questionnaire-12 (GHQ-12), suicide risk screening tool, memory decline awareness, sleep disorder questionnaire, and health-related quality of life (EuroQoL-5 dimension, EQ-5D) were used to assess mental health problems. Statistical analyses were performed using chi-square test, analysis of variance, and Pearson correlation analysis. Results：In the high nutrition risk group, GHQ-12 score was highest. In the good nutrition group, subjective memory impairment score and sleep difficulty were lowest, and EQ-5D index was highest. The risk of suicide tended to increase with increasing nutritional risk. Nutritional risk score was significantly correlated with GHQ-12, subjective memory impairment, sleep latency time, total sleep duration, sleep difficulty, and EQ-5D index. Conclusion：This study confirms that nutritional risk in the elderly is related to various psychological symptoms and low quality of life. High nutritional risk in the elderly warrants clinical attention to mental health and quality of life.

Association between Falls and Nutritional Status of Community-Dwelling Elderly People in Korea.

BackgroundMalnutrition is a well-known risk factor of falls, although studies examining the association between nutritional status and falls are rare. We aimed to investigate the association between nutritional status and falls according to gender among Korean older adults.MethodsThe study included 10,675 participants (4,605 men and 6,070 women) aged 65 years and older and used data from the 2011 Survey of Living Conditions and Welfare Needs of Korean Older Persons. Nutritional status of the participants was assessed using the Nutritional Screening Initiative checklist, and the participants were categorized into the following groups: “good,” “moderate nutritional risk,” and “high nutritional risk.” Odds ratios (OR) of fall risk in the above groups based on gender were evaluated using multivariate logistic regression analyses.ResultsFallers in both genders showed significant association with older age, lower household income, inadequate exercise, and poor nutritional status compared with non-fallers. Considering the good nutritional status group as the reference group, the high nutritional risk group showed a higher risk of falls in men (OR, 1.59; 95% confidence interval [CI], 1.26–1.99); both moderate and high nutritional risk groups showed a higher risk of falls after adjusting for confounding factors in women (OR, 1.39; 95% CI, 1.19–1.62 and OR, 1.90; 95% CI, 1.61–2.24, respectively).ConclusionThe risk of falls was associated with poor nutritional status, and statistical significance of the association between nutritional status and falls was stronger in women than in men.

Effect of Preoperative Nutritional Risk Screening on Postoperative Recovery in Patients with Laparoscopic-Assisted Radical Resection for Colorectal Cancer.

Results There were statistically significant differences in BMI, albumin, total cholesterol, and lymphocyte count between patients from the two groups (all P < 0.05). There was no difference in the incidence rate of postoperative complications between the two groups, but there was a statistically significant difference in the total number of complications (P < 0.05). There were no significant differences between the two groups regarding abdominal drainage volume, exhaust (flatus) time, hospitalization cost, morbidity, or 60 d readmission rate (all P > 0.05). However, patients with nutritional risk had higher postoperative blood transfusion volumes, albumin infusions, weight difference before and after surgery, and postoperative hospital stays than the nonnutritional risk group (all P < 0.05). Smoking, diabetes, and preoperative nutritional risk were the risk factors by the univariate and multivariate logistic regression analyses. Conclusions The postoperative complication rate was increased, and the short-term efficacy was decreased in the preoperative nutritional risk group compared with those without nutritional risk.

Abstract 431: Initial Nutrition Status is Associated With Neurologic Outcome in Post Cardiac Arrest Patients

Background: Poor nutrition is associated with mortality in critically ill patients. Also overweight BMI, low albumin is known to be associated with poor neurologic outcome in post cardiac arrest patients. We aimed to assess the association between initial nutritional status and poor neurologic outcome in post cardiac arrest patients. Methods: The nutrition support team(NST) initially assesse all patients admitted to the ICU in 24 hours of admission. All patients are screened for initial nutrition status with age, height, weight, laboratory results, signs of poor nutrition, nutrition risk comorbidities into consideration. We retrospectively analyzed the nutrition risk from the initial nutrition risk record assessed by NST and compared the nutrition risk between outcome groups. Furthermore, we did a multivariate logistic regression correcting for confounding variables to investigate the association between the initial nutrition risk and neurologic outcome. Results: High nutrition risk was associated with poor neurologic outcome (OR 3.03 [1.25-7.33], p=0.01) compared to the low nutritional risk group after adjusting for age, sex, CPR duration and initial shockable rhythm. Conclusion: High initial nutrition risk was associated with poor neurologic outcomes in our study.

Relationship between Postoperative Recovery and Nutrition Risk Screened by NRS 2002 and Nutrition Support Status in Patients with Gastrointestinal Cancer

Objective: Investigating incidence of nutritional risk and nutrition support in gastrointestinal cancer patients to provide reference for improving the clinical nutritional application level.Method: We evaluated the nutritional risk of gastrointestinal cancer patients who were newly admitted from September 2015 to February 2016 by Nutritional Risk Screening 2002 (NRS 2002).Results: Totally, 201 cases completed assessment by NRS 2002, and 69 cases (34.3%) were at nutritional risk. The incidence of nutritional risk was higher in patients with ≥65 (P < 0.05), with tumor size ≥ 5 cm (P < 0.05) or well-differentiated (P < 0.001). Incidence of nutritional risk in patients with BMI < 18.5 was higher than patients with BMI 18.5–25 and ≥25 (P < 0.05). Patients with nutrition risk had greater rate of anemia than with no risk. In nutritional risk group, 54 cases underwent enteral nutrition support, and their hospitalization stay was shorter, and the rates of complications were smaller (P < 0.05). Further multivariate logistic regression analysis showed NRS 2002 score, middle differentiation degree and III/I were the risk factors for postoperative complication.Conclusion: Preoperative NRS 2002 score was proved to be a predictive index for postoperative complication rate, and this indicates that patients with a high preoperative NRS 2002 score are at higher risk of developing postoperative complications and longer recovery period.

Geriatric nutritional risk index predicts all-cause deaths in heart failure with preserved ejection fraction.

AimsThe objective of the study was to evaluate whether the geriatric nutritional risk index (GNRI) at discharge may be helpful in predicting the long‐term prognosis of patients hospitalized with heart failure (HF) with preserved ejection fraction (HFpEF, left ventricular ejection fraction ≥50%), a common HF phenotype in the elderly.Methods and resultsOverall, 110 elderly HFpEF patients (≥65 years) from the Ibaraki Cardiovascular Assessment Study‐HF (n = 838) were enrolled. The mean age was 78.5 ± 7.2 years, and male patients accounted for 53.6% (n = 59). All‐cause mortality was compared between the low GNRI (<92) with moderate or severe nutritional risk group and the high GNRI (≥92) with no or low nutritional risk group. Cox proportional hazard regression models were constructed to evaluate the influence of the GNRI on all‐cause death with the following covariates using forward stepwise selection: age, sex, nutritional status based on the GNRI as a categorical variable, history of HF hospitalization, haemoglobin level, estimated glomerular filtration rate, log brain natriuretic peptide levels (logBNP), history of hypertension, log C‐reactive protein levels, left ventricular ejection fraction, left ventricular mass index, and the New York Heart Association functional classification (I/II or III class). The prognostic value of the GNRI was compared with that of serum albumin using C‐statistics. The GNRI was added to the logBNP, serum albumin or the body mass index was added to the logBNP, and the C‐statistic was compared using DeLong's test. Cox regression analysis revealed that age and a low GNRI were independent predictors of all‐cause death (P < 0.05, n = 103; hazard ratio = 1.095, 95% confidence interval = 1.031–1.163, for age, and hazard ratio = 3.075, 95% confidence interval = 1.244–7.600, for the GNRI). DeLong's test for the two correlated receiver operating characteristic curves [area under the receiver operating characteristic curve (AUROC) of serum albumin, 0.71; AUROC of the GNRI, 0.75] demonstrated significant differences between the groups (P = 0.038). Adding the GNRI to the logBNP increased the AUROC for all‐cause death significantly (0.71 and 0.80, respectively; P = 0.040, n = 105). The addition of serum albumin or the body mass index to the logBNP did not significantly increase the AUROC for all‐cause death (P = 0.082 and P = 0.29, respectively).ConclusionsNutritional screening using the GNRI at discharge is helpful to predict the long‐term prognosis of elderly HFpEF patients.

Nutritional risk screening and its clinical significance of infants with severe pneumonia

Objective To investigate the nutritional risk of hospitalized infants with severe pneumonia and its relationship with clinical outcome. Methods Totally 113 infants with severe pneumonia admitted to pediatric intensive care unit (PICU)were enrolled in the study. Nutritional risks were screened by STRONGkids, and the nutritional were assessment with WHO Anthro. Clinical outcomes were recorded and analyzed, including mechanical ventilation, length of PICU stay, total hospital expenses, prognosis, and biochemical test index. Results A total of 44 infants (38.9%) had high nutritional risk, 49 (43.4%) had medium nutritional risk, 20 (17.7%) had low nutritional risk when they admitted to PICU. A total of 59 (52.2%) infants were malnourished when they admitted to PICU. There was a significant correlation between the degree of malnutrition and nutritional risk (r=0.574, P<0.01).The incidence of high nutritional risk was significantly higher in 28d~1year-old group than in 1~3 year-old group (χ2=20.46, P<0.01). Nearly 42.5% (48/113) of the children had congenital disease and had higher incidence of high nutritional risk (χ2=11.375, P=0.003) and higher incidence of malnutrition (χ2=10.083, P=0.001) than those without congenital disease. The rate of mechanical ventilation (P=0.028), the duration of mechanical ventilation (P<0.01), total hospital expenses (P=0.002) and the incidence of poor prognosis(P=0.014) were significantly higher in high nutritional risk group than the low nutritional risk group. The retinol binding protein in the high nutrition risk group was significantly lower than the low nutrition risk group (χ2=6.333, P=0.021). Conclusions High nutritional risk and malnutrition are common in infants with severe pneumonia. Malnutrition and nutritional risk are increased in patients less than 1 year old or suffering from congenital disease. Patients with high nutritional risk are more likely to have worse clinical outcomes. STRONGkids is a valid tool for nutritional risk screening in hospitalized children, and early nutrition support is recommended. Key words: Severe pneumonia; Infant; Nutritional risk screening; Malnutrition

Nutritional risk factors are associated with postoperative complications after pancreaticoduodenectomy.

PurposeThe purpose of this study was to investigate whether the indicators of nutritional risk screening tool are associated with postoperative complications following pancreaticoduodenectomy (PD).MethodsWe investigated whether nutritional risk is associated with postoperative complications based on the medical records of 128 patients who underwent PD from 2010. The tool was composed of 6 risk factors: albumin, total lymphocyte count, body mass index, weight loss, dietary intake loss, and nutritional symptoms. The patients were divided into 2 groups: a nutritional risk group and a nonrisk group. The rates of general complications and postoperative pancreatic fistula (POPF) were investigated according to this nutritional status.ResultsThere were 65 patients who did not have any risk factors. However, 63 patients had one risk factor or more. In the nonrisk group, the overall complication rate and serious complication rate were 30.8% and 15.4%, respectively. If there were one or more risk factors, the overall and serious complication rates were 59.5% and 41.3%, respectively (P = 0.001 and P = 0.001, respectively). The rate of clinically relevant POPF (grade B or C) was 9.2% in the nonrisk group. However, this rate was 23.8% in the NRS risk group (P = 0.029). In multivariate analysis, the NRS risk group was a significant factor of clinically relevant POPF (odds ratio, 9.878; 95% confidence interval, 1.527–63.914; P = 0.016).ConclusionThere were statistically significant associations between complications and nutritional indicators. A comprehensive analysis of nutritional parameters will help predict postoperative complications.

Targeted Energy Intake Is the Important Determinant of Clinical Outcomes in Medical Critically Ill Patients with High Nutrition Risk.

The clinical conditions of critically ill patients are highly heterogeneous; therefore, nutrient requirements should be personalized based on the patient’s nutritional status. However, nutritional status is not always considered when evaluating a patient’s nutritional therapy in the medical intensive care unit (ICU). We conducted a retrospective cross-sectional study to assess the effect of ICU patients’ nutrition risk status on the association between energy intake and clinical outcomes (i.e., hospital, 14-day and 28-day mortality). The nutrition risk of critically ill patients was classified as either high- or low-nutrition risk using the modified Nutrition Risk in the Critically Ill score. There were 559 (75.3%) patients in the high nutrition risk group, while 183 patients were in the low nutrition risk group. Higher mean energy intake was associated with lower hospital, 14-day and 28-day mortality rates in patients with high nutrition risk; while there were no significant associations between mean energy intake and clinical outcomes in patients with low nutrition risk. Further examination of the association between amount of energy intake and clinical outcomes showed that patients with high nutrition risk who consumed at least 800 kcal/day had significantly lower hospital, 14-day and 28-day mortality rates. Although patients with low nutrition risk did not benefit from high energy intake, patients with high nutrition risk are suggested to consume at least 800 kcal/day in order to reduce their mortality rate in the medical ICU.

Relationship between nutritional status and the clinical outcomes of critically ill children

Objective To investigate the nutritional status and the clinical outcome of the critically ill children, and to provide scientific evidence for further clinical nutrition management. Methods Nutritional risk screening was performed on 1 183 critically ill children hospitalized at the Intensive Care Unit (ICU), Children′s Hospital of Nanjing Medical University from October 2016 to October 2017 by using the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids), the ICU including of Pediatric Intensive Care Unit (PICU), Surgical Intensive Care Unit (SICU) and Coronary Care Unit (CCU). Median age of the children was (2.6±2.4) years (29 d-12.9 years). Nutritional status was estimated, and scores of anthropometric parameters such as weight-for-age Z-score (WAZ) (<5 years) or body mass index-for-age Z-score (BAZ) (≥5 years)were calculated.The data on incidence of infectious complications, duration of ICU stay and mechanical ventilation, the total hospital expenses and in-hospital mortality were recorded. Results Of the 1 183 cases, 134 children(11.3%) had low nutritional risk, 746 children(63.1%) had moderate nutritional risk and 303 children(25.6%) high nutritional risk.The prevalence of severe malnutrition, moderate malnutrition and mild malnutrition was 8.1% (96/1 183 cases), 8.2% (97/1 183 cases), and 12.8% (151/1 183 cases) respectively.The severe malnutrition group had a higher incidence of high nutritional risk than other groups [74.0%(71/96 cases) vs.67.0%(65/97 cases), 40.4%(61/151 cases), 12.6%(106/839 cases)], and the differe-nce was statistically significant (P<0.001). The incidence of high nutritional risk in the CCU was higher than that than that in the PICU and SICU, and the difference was statistically significant [36.5%(96/263 cases), 23.8%(125/524 cases) and 20.7%(82/396 cases) respectively, P<0.01]. And the incidence of high nutritional risk was higher in infants[37.6%(198/527 cases)] than those in the other age groups[18.4%(52/282 cases), 12.0%(21/175 cases), 16.0%(32/199 cases)], and the difference was statistically significant (χ2=68.90, P<0.000 1). Children with a high nutritional risk had increased incidence of infectious complications [8.6%(26/303 cases) vs.4.7%(35/746 cases), 3.7%(5/134 cases)], incidence of mechanical ventilation[66.0%(200/303 cases) vs.41.4%(309/746 cases), 38.8%(52/134 cases)] and total hospital expenses (￥52 500 vs.￥39 700 and ￥48 700 RMB) compared with those with the moderate or the low nutritional risk, and the differences were statistically significant(all P<0.05). There were 16 deaths and 8 deaths (2.7%) in the high nutrition risk group, which was significantly higher than those in the moderate nutrition risk group [8 cases (1.1%)] and the low nutrition risk group[0 case(0)] (χ2=7.60, P=0.02). Conclusions Moderate or high nutritional risk is seen in the critically ill children, especially in infants and the children with congenital heart disease.Nutritional risk score is correlated with clinical outcomes.Nutritional risk screening and standard nutritional support are recommended so as to improve clinical treatment outcomes. Key words: Nutritional risk screening; Critically ill; Clinical outcome; Child