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Objective:To investigate the clinical value of nutritional indexes including body mass index (BMI), albumin (ALB), nutrition risk screening 2002 (NRS 2002) and the nutrition risk in critically ill score (NUTRIC) in 28-day prognosis of patients with sepsis related acute kidney injury (AKI).Methods:A prospective cohort study was conducted. Patients with sepsis treated in the emergency intensive care unit (EICU) of China Rehabilitation Research Center from December 1, 2018 to December 1, 2020 were observed for 7 days. Patients with sepsis related AKI were enrolled in this study. The gender, age, BMI, basic diseases, shock, number of affected organs, length of hospital stay, ALB, mechanical ventilation (MV) and vasoactive drug use, sequential organ failure score (SOFA), rapid sequential organ failure score (qSOFA) and acute physiology and chronic health evaluationⅡ(APACHEⅡ) were recorded. The NRS 2002 score and NUTRIC score were calculated. Cox regression model was used to analyze the risk factors of 28-day mortality in patients with sepsis related AKI. The receiver operator characteristic curves (ROC curves) were drawn and the areas under the ROC curves (AUC) were calculated, and the value of BMI, ALB, NRS 2002 score and NUTRIC score was analyzed to predict 28-day mortality in patients with sepsis related AKI. Kaplan Meier survival curves were used to analyze the effects of NRS 2002 score and NUTRIC score stratification on the 28 day prognosis of patients with sepsis related AKI.Results:A total of 140 patients with sepsis related AKI were enrolled, including 73 survival patients and 67 died patients within 28 days. The 28-day mortality was 47.9% (67/140). BMI in the survival group was significantly higher than that in the death group [kg/m 2: 22.0 (19.5, 25.6) vs. 20.7 (17.3, 23.9), P < 0.05], and NRS 2002 score and NUTRIC score were significantly lower than those in the death group [NRS 2002 score: 5 (4, 6) vs. 7 (6, 7), NUTRIC score: 6 (5, 7) vs. 7 (6, 9), both P < 0.05]. The ALB of the survival group was slightly higher than that of the death group, but the difference was not statistically significant. Cox regression analysis showed that NRS 2002 score and NUTRIC score were independent risk factors for 28-day death in patients with sepsis related AKI. ROC curve analysis showed that NUTRIC score had the strongest predictive ability for 28-day death [AUC = 0.785, 95% confidence interval (95% CI) was 0.708-0.850], followed by NRS 2002 score (AUC = 0.728, 95% CI was 0.647-0.800), but there was no significant difference between them. Compared with NRS 2002 score, the predictive ability of BMI and ALB was poor. Kaplan-Meier curve analysis showed that the prognosis of patients with NRS 2002 score≥5 was significantly worse than that of patients with NRS 2002 score < 5 (28-day cumulative survival rate: 42.1% vs. 75.6%, Log-Rank test: 2 = 11.884, P = 0.001), and the prognosis of patients with NUTRIC score≥6 was significantly worse than that of patients with NUTRIC score < 6 (28-day cumulative survival rate: 40.4% vs. 86.1%, Log-Rank test: 2 = 19.026, P = 0.000). Conclusions:Patients with sepsis related AKI have high nutritional risk. Both NRS 2002 score and NUTRIC score have good predictive value for the prognosis of patients with sepsis related AKI, while BMI and ALB have low predictive value. Due to the complex calculation of NUTRIC score, NRS 2002 score may be more suitable for emergency department.
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Objective To investigate the relationship between nutritional risk status and implementation of nutrition therapy in mechanical ventilated (MV) chronic obstructive pulmonary disease (COPD) patients, so as to provide evidence for individualized nutrition therapy. Methods A prospective multicenter observational study was conducted. MV COPD patients admitted to Department of Intensive Care Units (ICU) of 10 County Hospitals in Zhejiang Province from January 2015 to January 2016 were enrolled, and according to nutrition risk screening 2002 (NRS2002) score, they were divided into nutritional high risk group (NRS2002 3-5) and nutritional extremely high risk group (NRS2002 6-7). Nutrition therapy situation and hospital mortality were compared between the two groups; multivariate Cox regression analysis was used to analyze the risk factors affecting the prognosis of patients with COPD under mechanical ventilation. Kaplan-Meier curve was used to analyze the prognosis at 30 days; receiver operating characteristic (ROC) curve was used to test the robustness of multivariable regression analysis. Results ① One hundred and six COPD patients with MV were analyzed; among them, 90 patients were in the nutritional high risk group, and 16 were in the nutritional extremely high risk group. There were no significant differences in age, gender and body mass index (BMI) between the two groups (all P > 0.05); the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, NRS2002 score in patients of nutrition risk extremely high group were obviously higher than that in patients with nutrition high risk group (APACHEⅡ: 24.9±6.1 vs. 20.3±5.8, NRS2002 score: 6.3±0.5 vs. 4.2±0.8, both P < 0.05). ② Patients in both groups received early enteral nutrition (EN) therapy, the proportion of patients in nutritional extremely high risk group received early EN was lower than that of patients in the nutritional high risk group [12.5% (2/16) vs. 17.7% (16/90)], along with the prolongation of hospital stay, the proportions of patients beginning to receive the EN were gradually increased in the nutrition extremely high risk group and high risk group, after 2 days the EN increased significantly, and reached the highest value on day 6 after entering ICU [100.0% (16/16), 98.9% (89/90), respectively]; within 3 days after admission into ICU, the proportion of EN in nutrition extremely high risk group was obviously lower than that in nutrition high risk group, and from day 4, there was no statistical significant difference in proportion of EN between the two groups (all P > 0.05). The time to start parenteral nutrition (PN) treatment was relatively early admission to the ICU on day 1 and the proportion of this therapy was high in the two groups [56.2% (9/16), 27.7% (25/90), respectively], the PN proportion did not decrease with the length of hospitalization and the increase of EN. The proportion of patients in the nutrition extremely high risk group who started PN treatment was higher, which reached 56.2% admission to the ICU on day 1.③ With extension of hospital stay, the calories of EN were gradually increased in the nutritional high risk group, the highest calories in nutritional high risk groups was 4 318 (3 912, 4 812) kJ/d at day 7; while the highest calories in nutritional extremely high risk groups was 3 602 (2 167, 4 615) kJ/d at day 6 and a slight decreased at day 7; the difference of calories within the first week between the two groups had no significance (all P > 0.05). The calorific value of PN therapy remained at a constant level during hospitalization within 7 days, and after admission into ICU for 4-5 days, the target range of calories was achieved. ④ Kaplan-Meier survival curve analysis showed that the mortality at 30 days in the extremely high risk group was significantly higher than that in the high risk group [62.5% (10/16) vs. 11.1% (10/90), χ2 = 15.4, P < 0.01]. ⑤ Multiple cox-regression analysis showed that NRS2002 scoring was the independent risk factor affecting the mortality of patients in hospital [odds ratio (OR) = 2.08, 95% confidence interval (95%CI) = 1.39-3.12, P = 0.005]. ⑥ ROC curve analysis: according to ROC curve analysis of the effectiveness of multi-factor regression model, area under ROC curve (AUC) was 0.79, sensitivity was 70.00%, specificity was 74.42%, positive likelihood ratio was 2.74, negative likelihood ratio was 0.40, 95% confidence interval (95%CI) was 0.702-0.864, P = 0.001, and it showed that the regression model had a good prediction effect. Conclusions MV COPD patients have significant nutritional risk and all receive early EN therapy. The proportion of beginning to use PN treatment in patients with nutritional extremely high risk is relatively high. Initial nutritional status is the independent risk factor of poor prognosis in MV patients with COPD.
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Objective To evaluate the application of clinical Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP),and to investigate the nutritional risks of inpatient children with gastroenterological diseases in Sichuan province and their associated clinical characteristics and the features of hygiene economics.Methods STAMP was utilized for nutrition screening of inpatient children with gastroenterological diseases in Chengdu Women and Children's Central Hospital from January 2015 to March 2017.All the enrolled children were divided into 3 groups according to the STAMP scores:low risk group (LR group),moderate risk group (MR group) and high risk group (HR group).Clinical and economic data were compared among 3 groups.Results A total of 3 672 assessments were accomplished,including 2 372 times for males and 1 300 times for females (＜ 2 years old:2 021 times,2-5 years old:803 times,＞5 years old:848 times).Among them,147 children were identified as LR(4.00％),2 296 children as MR (62.53％),and 1 229 children as HR (33.47％).Statistically significant differences were observed among 3 groups in average length of hospital stay (P ＜0.001),the total cost at hospital (P ＜0.001),drug cost (P ＜ 0.001),antibiotic use (x2 =21.66,P ＜ 0.001),parenteral nutrition administration (x2 =46.43,P ＜ 0.001),blood products use (x2 =45.00,P ＜ 0.001),while there was no significant difference in re-admissions for over 3 times (P ＞ 0.05).Malnutrition rate was 4.08％ (6/147 cases) in LR group,2.05％ (47/2 296 cases) in MR group and 31.90％ (392/1 229 cases) in HR group,respectively,and among them 146 patients were diagnosed as severe malnutrition.Digestive tract infections were the most common diseases in MR group(66.33％,1 523/2 296 cases) and HR group(68.27％,839/1 229 cases).Moreover,children with stomatitis,gastrointestinal postoperation,acute pancreatitis,inflammatory bowel disease,esophageal diseases,digestive malformations,cyclic vomiting,malnutrition,and acute intestinal obstruction were all in HR group.Conclusions Nutritional risk is likely to raise the burden of disease.STAMP is applicabile clinically when it is utilized for nutrition risk screening of inpatient children with gastroenterological diseases in Sichuan province and provides evidence for nutrition support treatment.
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The conception of nutrition risk and malnutrition risk are not strictly differentiated in clinical.Nutri-tional risk was associated with a higher complications incidence,mortality and longer length of hospital stay.It′s nece-ssary to carry out nutrition risk screening to decide whether the need for nutritional intervention.This article introduces the clinical epidemiological characteristics of nutritional risk in children,nutrition risk score,nutritional risk screening, subjective global assessment,and screening tool for risk of impaired nutritional status and growth.It′s very important to apply a rapid and easy nutrition risk screening tools.Then,also discussions the relationship between nutritional risk screening and nutritional therapy,put forward on the strategies for assess and prevent malnutrition in children,and loo-king for the best way of nutritional support to ensure the body and cells metabolism,reduce the extent of tissue damage and promote the recovery of the disease.
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Malnutrition has traditionally been regarded as a global concern,especially in the developing countries. Malnutrition seems more prevalent in hospitalized patients, with potentially serious consequences, it may increase susceptibility to infection and mortality and lengthen the stays in hospital,which lead to additional health care costs. Along with the development of the screening tools,it plays an increasingly important role in the nutritional problems in adults. Recently several nutritional screening tools have been applied in pediatrics,but the lack of the universal acceptable tools is still a problem demanding prompt solution. This review aims to compare the nutritional screening tools that are currently available in clinic and their drawbacks in daily work.
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Nutrition Risk Screening 2002 (NRS 2002) was developed on the basis of 128 randomized controlled clinical studies by a group of experts led by Kondrup from the European Society for Parenteral and Enteral Nutrition (ESPEN).As the first evidence-based nutritional screening tool worldwide,NRS 2002 has been recommended for nutritional risk assessment of hospitalized patients in Europe for the addition of disease metabolism and its simplicity.In this article,we reviewed the increasing applications of NRS 2002 in China,pointed out the existing problems and made several suggestions on improvement for popularization and standardization of its clinical use.
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Objective Using Nutrition Risk Screening (NRS 2002),to assess the nutritional risk of inpatients with digestive diseases and evaluate its clinical significance.Methods The information of 274 patients med the inclusion criteria were collected in our department from August to October 2011.Nutrition status was assessed according to NRS 2002 by trained nurses.Results The prevalence of nutritional risk was 22.99 ％ (63/274).The rate of nutritional risk of the elderly inpatients (≥ 65y) with digestive diseases was significant higher the younger ones (＜ 65y)(32.95％ vs 18.28％,P ＜ 0.05).74.6％ inpatients with nutritional risk and 52.13％ with no risks were given enteral or parenteral nutritional support during the hospitalized period.Conclusion There was higher nutritional risk rate in inpatients with digestive diseases,especially the elderly ones.For deferent patients,the nutritional support should be on the basis of patient' s nutritional state.
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It's known that ICU patients is in critical condition and might deteriorate rapidly,so it's important for them to get appropriate nutritional support in order to recover.We must make proper nutrition treatment plan for patients according to their different nutritional condition and potential risk.Nutritional risk screening can not only assess the nutritional status of children,is more likely to predict its potential nutritional risk,to guide nutritional support treatment plan,and ultimately improve the prognosis.Looking out for comprehensive,simple,fast,and easy nutritional risk screening tools as soon as possible and appropriate nutrition risk screening is significantly for growth and development as well as prognosis of ICU patients.
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Objective To investigate hospitalized children's nutritional risk and malnutrition occurrence,and to provide clinical basis for nutrition support.Methods Nutritional risk screening tool STRONGkids was applied to 651 cases of hospitalized children with nutritional risk screening,and through physical measurement to assess children' s nutritional status,at the same time during the patient's diagnosis,the length of time data for analysis was recorded.Results Of 651 cases of hospitalized children,7.07％ (46 cases) were of highly nutritional risk,80.95％ (527 cases) with moderate nutrition risk,and 11.98％ (78 cases) were of low nutrition risk.Malnutrition rate was 22.58％,moderate malnutrition in 111 cases (17.05％),severe malnutrition in 36 cases (5.53％).The first three high risk diseases were congenital heart disease,chronic liver disease and chronic kidney disease(x2 =21.43,P ＜0.01).According to the result of nutrition evaluation concluded with congenital heart disease,chronic kidney disease occurred with severe malnutrition was far higher than other diseases(x2 =16.53,P ＜ 0.05).Children with highly nutritional risk were more likely to have weight loss than the children with relatively low nutritional risk (P ＜ 0.05),and their length of hospital stay were obviously longer than the children with low or moderate nutritional risk (P ＜ 0.05).Conclusions The hospitalized children have high incidence of malnutrition,and different nutritional risks lead to different clinical outcomes.STRONGkids score method helps to evaluate nutritional risk in hospitalized children and detect malnutrition and potential deterioration,which is conducive to early comprehensive nutritional assessment and proper nutritional treatment,thus to improve their clinical outcomes.
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Objective To evaluate the preoperative nutritional status of the patients which were preparing for cardiac valves replacement using nutrition risk screening 2002 (NRS2002),and analyze the evaluation effect and bring forward the corresponding nursing interventions.Methods 226 patients who would carry out cardiac valves replacement in the context of extracorporeal circulation were evaluated by NRS2002 preoperatively.88 patients had nutrition risk.Those elective 88 patients were randomly assigned into the experimental group and the control group,each had 44 cases.Then different nursing measures were implemented in each group and the clinical outcome was contrasted in the two groups.Results In the patients who were preparing for cardiac valves replacement,88 cases had preoperative nutrition risk score ≥3 points and 138 cases ＜ 3 points.Preoperative nutrition risk score had positive correlation with heart function grade.Difference of the experimental group and the control group in length of stay,length of mechanical ventilation after surgery and incidence rate of general complications had statistical significance.Conclusions It is effective to analyze the preoperative nutritional status of the patients with cardiac valves replacement by NRS2002.It may improve prognosis effectively by providing preoperative nursing interventions for patients with nutrition risk.Besides,it provides theoretical basis for further studying the relation between nutrition support and clinical outcome of patients with nutrition risk.
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ObjectiveTo explore the clinical outcome of the combined nutrition support for colorectal cancer patients.MethodsTwo research arms were obtained using a cohort sampling method.Ann A ( the study group): from 2009 to 2010,30 colorectal cancer patients were enrolled.They received nutritional risk screening (NRS) 2002 after admission.Nutritional risk was defined as NRS 2002 score ≥3 three days before operation.Patients with nutritional risk received enteral nutrition (EN) for bowel preparation without laxative drug and enema.After operation,they received EN combined with parenteral nutrition (PN) supports provided.Arm B (control group): 30 cases with historically confirmed colorectal cancer were enrolled from 2007 to 2008.They received routine bowel preparation (diet control,laxative drug,and enema) and PN supports after operation.Nutritional parameters,the rate of infectious complications,the rate of systemic inflammatory response syndrome,and the duration of hospital stay were analyzed.ResultsThere were no significant difference in body weight and plasma albumin between these two arms ( P ＞ 0.05 ). The incidence of systemic inflammatory response syndrome (13.3 ％ ),infectious complications (10.0％ ),and the duration of hospital stay [ (12.3 ± 6.5 ) d ] in arm A were significantly lowerthan those in arm B [33％,30％,and (15.0 ±7.2) d,respectively] (P =0.038,P =0.042,P =0.045).Conclusion For the colorectal cancer patients,nutritional risk screening on admission,bowel preparation with eneral nutrition before operation,and combined nutritional support after operation can improve the clinical outcome.
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Objective To summarize the clinical outcomes after the optimization of nutrition support in elderly patients after hepatic carcinoma surgery.Methods The clinical data of 52 elderly patients with hepatic carcinoma in Beijing Hospital were collected and analyzed from 2007 to 2009(research group).Nutritional Risk Screening(NRS)2002 was applied for the nutrition risk screening at admission.NRS 2002 score≥3 was regarded as at nutritional risk.Enteral nutrition(EN)or EN combined with parentoral nutrition(EN+PN)supports were provided during the peri-operative stage.The control group included 30 patients from 2005-2007 under the same conditions with rescareh group but only received PN supports pest-operatively.Nutritional parameters,complications,lengh of hospital stay,and healthcare expenditures were analyzed.Results Body weight and plasma albumin were no significantly different in two groups(P>0.05)by the 7th post-operative day.The incidence of infection-relatod complications and length of hospital stay were significantly lower in research group than in control group (P<0.05).Conclusions Nutrition risk screening should be performed for the elderly patients with hepatic carcinoma after admission.Optimization of peri-operative nutrition support can reduce complications and improve the clinical outcomes.
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Objective To investigate the incidences of nutrition risks, malnutrition ( undernutrition),overweight, and obesity, and nutrition support in tertiary hospitals in Xinjiang Uigur Autonomous Region. Methods Using fixed-point consecutive sampling, we collected the clinical data of inpatients in 6 departments of five tertiary hospitals in Xinjiang. According to the Nutrition Risk Screening 2002 (NRS 2002 ) published by European Society for Parenteral and Enteral Nutrition, patients were graded as at nutritional risk when their NRS 2002 scores ≥3 and as malnutrition when the body mass index (BMI) was ＜ 18.5 kg/m2 (or albumin ＜ 30 g/L). NRS 2002 screening was performed on the next morning after a patient was admitted. The nutrition supports within 2 weeks after admission were also investigated. The relationship between nutrition risks and nutrition support was analyzed.Results A total of 4036 inpatients were investigated, among them 3913 patients received NRS 2002 screening.The malnutrition (undernutrition) rate and the proportion of patients at nutritional risk were 8.4% and 34. 2%, respectively. The percentage of nutrition support was 10. 2%, which included parenteral nutrition (8. 5% ) and ena simple, fast and convenient tool for the investigation of nutrition risks and can provide a basis for reasonable nutrition support Therefore, it should be widely applied in clinical practice.