NRS-2002 components, nutritional score and severity of disease score, and their association with hospital length of stay and mortality

Abstract

BACKGROUND: Malnutrition is a substantial issue in hospitals, leading to prolonged length of hospital stay, increased perioperative morbidity and increased mortality. There are several validated screening tools for malnutrition, one of which is the Nutritional Risk Screening 2002 (NRS). It screens patients based on recent weight loss, reduction of recent food intake, body mass index (BMI), severity of disease and age. Higher NRS scores have been shown to be negatively associated with patients' outcomes such as increased morbidity and mortality. OBJECTIVES:The aim of the study was to evaluate how the two NRS components Nutritional Score (NS) and Severity of Disease Score (SDS) are associated with patients' length of hospital stay and mortality.METHODS: All patients admitted to the medical department of a large community hospital in Switzerland were screened for malnutrition using the nutrition screening NRS during the years 2014 to 2017. Data on patients' NRS, primary diagnosis, number of secondary diagnoses, mortality, length of stay (LOS), discharge, sex and age were collected. The association between the NRS components and LOS/mortality was estimated using a linear mixed-effects regression model and a logistic regression model, respectively, with adjustment for confounders (age, sex, comorbidity, diagnosis group, mode of discharge and year of hospitalisation). RESULTS:The evaluation of the outcomes of 21,855 hospitalisations demonstrated that the NS was associated with an increment in the LOS of 5.5-12.3% per score point, depending on the diagnosis group. An increase in the SDS by one point was associated with an increase in the LOS of 2.2-11.3%. The odds for all-cause in-hospital mortality were increased by 44.1% (95% confidence interval [CI] 33.7-55.2%) per point in the NS, and by 73% (95% CI 57.5-90.1%) per point in the SDS. CONCLUSIONS: Increases in both components of the NRS are associated with longer LOS. The NS has a slightly stronger impact on LOS compared to the SDS and its effect is dependent on the patient's diagnosis group. Increases in the SDS are linked to a higher mortality than increases in the NS.

Nutritional Interventions May Improve Outcomes of Patients Operated on for Diabetic Foot Infections: A Single-Center Case-Control Study

“…As we have published previously, specific antibiotic-related variables (duration of systemic therapy, administration by the intravenous route) were not associated with the overall risk of clinical failure in these multifaceted DFI populations [ 2 , 3 , 10 ]. Our results confirm those of previous studies in other fields of medicine that have shown that a higher NRS-Score can be associated with a longer hospital stay [ 7 ]. Importantly in this regard is that we also found that providing nutritional interventions may decrease the duration of hospitalization.…”

“…We used a DFI registry that we developed, which lists all episodes occurring since the year 2000 [ 6 ]. One author (VT) completed the registry for his master degree, with five additional variables: an internationally validated nutrition score [ 7 ], a history of involuntary weight loss, treatment with vitamin substitutions or other nutritional interventions by our professional nutritionists, and the serum albumin level on admission (if available). Since 2003, we used the standardized NRS-Score (Nutritional Risk Screening Score 2002, with a range of 0 to 7) [ 7 ] throughout the study period.…”

“…The nutritional status is based on nutrition-related information acquired from patient interviews or the patient's weight or body mass index (BMI). The scoring system for severity of disease was created based on how well selected patient outcomes with certain diagnoses improved as a response to meeting daily caloric and protein requirements with nutritional support [ 7 ]. We purposely did not define the term “malnutrition,” since it is a confusing, complex term with no universally agreed definition.…”

A prospective epidemiological analysis of controlling nutritional status score with the poor functional outcomes in Chinese patients with haemorrhagic stroke

“…We set 2 as the cut-off value for CONUT score by a receiver operating characteristics (ROC) curves analysis (online Supplementary Fig. S1) and categorised the patients into low-CONUT and high-CONUT groups according to the CONUT score: no or low risk of malnutrition (0-1) and high malnutrition risk (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The NRS-2002 score of ≥ 3 points indicates that the patient is at nutritional risk (23) , considering the impaired nutritional status, the severity of the disease and the patients' age.…”

“…Several quantitative tools with scoring scales have been developed to assess nutritional risk, postoperative complications and long-term outcomes, such as the prognostic nutritional index and Nutritional Risk Screening index (NRS-2002) (8,9) . NRS-2002, as a standard method to assess nutritional risk, has been validated and conducted in hundreds of reported studies (10,11) . Controlling nutritional status (CONUT) is a newly proposed screening tool for assessing nutritional status and has been validated in several clinical settings (12,13) .…”