Analysis of Outcomes of the NRS 2002 in Patients Hospitalized in Nephrology Wards

Borek, Paulina; Chmielewski, Michael S.; Małgorzewicz, Sylwia; Dębska-Ślizień, Alicja

doi:10.3390/nu9030287

Cited by 27 publications

(20 citation statements)

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“…In our study, 46 549 inpatients from five institutions were enrolled between 1 June 2012 and 31 December 2017 and followed up for 5-63 months. The patients with NRS-2002 scores ≥3 had a greater risk of AKI and longer LOS and higher mortality rates than the patients with normal nutritional status, which was consistent with previous studies that undernourished patients were generally hospitalised longer and had lower survival rates (13,38) . Without effective intervention, AKI can develop irreversibly in patients with CKD and end-stage renal disease (5) and increase mortality.…”

Section: Discussionsupporting

confidence: 90%

“…The prevalence of malnutrition is 15-80 % in hospitalised patients, while only 3 % could be diagnosed and treated (8,12) . It has been reported that over 40 % of CKD patients are undernourished (13) and uraemia and dialysis can impact the nutritional status of patients with kidney disease (14,15) . AKI as the spread of inflammatory processes from the kidney to other organ systems is also affected by metabolic changes and undernutrition.…”

mentioning

confidence: 99%

“…The Nutritional Risk Screening 2002 (NRS-2002), developed by the European Society for Clinical Nutrition and Metabolism (ESPEN) (25) , has been widely used in clinical malnutrition screening and validated for assessing the nutritional status of patients for nutritional intervention in a variety of diseases (26,27) including CKD (13,28) . The NRS-2002 was composed of a score for impaired nutritional status, a score for the severity of disease and an additional score if age ≥70 years (25) , which recognise malnutrition if total score of NRS-2002 ≥3 (29) .…”

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confidence: 99%

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Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China

Chen

et al. 2019

Br J Nutr

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Malnutrition and acute kidney injury (AKI) are common complications in hospitalised patients, and both increase mortality; however, the relationship between them is unknown. This is a retrospective propensity score matching study enrolling 46 549 inpatients, aimed to investigate the association between Nutritional Risk Screening 2002 (NRS-2002) and AKI and to assess the ability of NRS-2002 and AKI in predicting prognosis. In total, 37 190 (80 %) and 9359 (20 %) patients had NRS-2002 scores <3 and ≥3, respectively. Patients with NRS-2002 scores ≥3 had longer lengths of stay (12·6 (sd 7·8) v. 10·4 (sd 6·2) d, P < 0·05), higher mortality rates (9·6 v. 2·5 %, P < 0·05) and higher incidence of AKI (28 v. 16 %, P < 0·05) than patients with normal nutritional status. The NRS-2002 showed a strong association with AKI, that is, the risk of AKI changed in parallel with the score of the NRS-2002. In short- and long-term survival, patients with a lower NRS-2002 score or who did not have AKI achieved a significantly lower risk of mortality than those with a high NRS-2002 score or AKI. Univariate Cox regression analyses indicated that both the NRS-2002 and AKI were strongly related to long-term survival (AUC 0·79 and 0·71) and that the combination of the two showed better accuracy (AUC 0·80) than the individual variables. In conclusion, malnutrition can increase the risk of AKI and both AKI and malnutrition can worsen the prognosis that the undernourished patients who develop AKI yield far worse prognosis than patients with normal nutritional status.

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Section: Discussionsupporting

confidence: 90%

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confidence: 99%

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confidence: 99%

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Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China

Chen

et al. 2019

Br J Nutr

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“…Llama la atención que nuestros resultados mostraron un alto porcentaje de riesgo nutricional en los pacientes del servicio de nefrología 95,26 % (n = 503). Esto difiere del estudio de Borek, et al (13) , el cual mostró que, utilizando la misma herramienta, 40 % de 292 pacientes admitidos de manera consecutiva durante seis meses al servicio de nefrología de un hospital universitario presentaron riesgo de desnutrición.…”

Section: Discussionunclassified

“…La población del servicio de nefrología ingresa al hospital en forma recurrente al tratamiento dialítico, lo cual puede influir en la prevalencia de riesgo encontrada. Existe evidencia de que la población nefrópata tiene un alto riesgo de desnutrición (13) relacionado con condiciones hipermetabólicas e infecciosas (14)(15)(16)(17) .…”

Section: Discussionunclassified

Relación entre el riesgo nutricional y el número de interconsultas realizadas al servicio de nutrición clínica según el servicio hospitalario

Gonzalez¹,

Altamirano²,

Rosales³

et al. 2018

Rev. Nutr. Clin. Metab.

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Antecedentes: la nutrición clínica es una disciplina que ha tenido gran impacto en los últimos años. Sin embargo, en el ámbito hospitalario es necesario que los médicos tratantes hagan un seguimiento más minucioso a los pacientes con riesgo nutricional con el fin de ofrecer el tratamiento nutricional oportuno. Objetivo: evaluar la proporción de interconsultas al servicio de nutrición clínica comparado con el porcentaje de riesgo nutricional de cada servicio. Metodología: se realizó un estudio observacional, analítico, transversal en los servicios del Hospital General de México, en el cual se comparó el número de pacientes diagnosticados con riesgo nutricional, evaluado mediante la herramienta NRS-2002 y el número de interconsultas que se recibieron por servicio hospitalario durante un año. Los datos recolectados de los registros de cada área fueron valorados en forma de proporciones por medio del programa STATA V. 14. Resultados: se analizaron en total 31.225 pacientes, de los cuales el 19,20 % presentó riesgo nutricional. A 81,42 % de los pacientes con riesgo nutricional les solicitaron interconsulta al servicio de nutrición clínica. Los servicios con mayor porcentaje de riesgo nutricional fueron nefrología (95,26 %), geriatría (66,46 %) y oncología (63,23 %). Los servicios con menor número de interconsultas fueron oftalmología (1), urología (91), nefrología (67) y geriatría (70) a pesar de tener un porcentaje importante de pacientes con riesgo nutricional. Conclusión: el porcentaje de solicitud de interconsulta al servicio de nutrición clínica por parte del médico tratante no se relaciona con el porcentaje de riesgo nutricional por servicio. Se hace necesario generar conciencia sobre el seguimiento nutricional a los pacientes hospitalizados.

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Nutrition Therapy in Non-intubated Patients with Acute Respiratory Failure

et al. 2021

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Purpose of Review A challenging aspect of the care for patients with acute respiratory failure is their nutrition management. This manuscript consists of a literature review on nutrition therapy in non-intubated patients with acute respiratory failure receiving high-flow nasal cannula oxygenation or non-invasive positive pressure ventilation. Recent Findings Studies show that non-intubated patients with acute respiratory failure either on non-invasive ventilation or high-flow nasal cannula are largely underfed in the initial phase of their hospitalization. Although data is limited, the available evidence suggests the feasibility of initiating oral diet in the majority of these patients in the early phase. Summary Initial evaluation includes mental status evaluation, the Yale swallowing screening protocol, and an assessment of severity of illness. The goal should be to initiate oral diet within 24 h. If patient cannot initiate oral diet, the reason for not initiating oral diet should dictate the next step. For instance, if the reason is failure of the swallow screening, further evaluation with fiberoptic endoscopy is warranted. The inability to provide oral diet for a patient in respiratory distress may a harbinger of failure of non-invasive oxygen therapy and should prompt consideration for endotracheal intubation. We suggest placement of a small-bore feeding tube for enteral nutrition if patient is unable receive oral diet after 48 h. Conclusions The nutrition management of these patients is better provided by a multidisciplinary team in a protocolized manner.

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Analysis of Outcomes of the NRS 2002 in Patients Hospitalized in Nephrology Wards

Cited by 27 publications

References 20 publications

Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China

Malnutrition screening and acute kidney injury in hospitalised patients: a retrospective study over a 5-year period from China

Relación entre el riesgo nutricional y el número de interconsultas realizadas al servicio de nutrición clínica según el servicio hospitalario

Nutrition Therapy in Non-intubated Patients with Acute Respiratory Failure

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