Nutritional risk is a predictor for long-term mortality: 5-Year follow-up of the EFFORT trial.
Aged
Comorbidity
Female
Food Service, Hospital
Humans
Inpatients
/ statistics & numerical data
Male
Malnutrition
/ etiology
Middle Aged
Nutrition Assessment
Nutrition Therapy
/ methods
Outcome Assessment, Health Care
Patient Admission
/ statistics & numerical data
Precision Medicine
/ methods
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Risk Assessment
Severity of Illness Index
Long-term mortality
Malnutrition
NRS 2002
Nutritional screening
Nutritional support
Journal
Clinical nutrition (Edinburgh, Scotland)
ISSN: 1532-1983
Titre abrégé: Clin Nutr
Pays: England
ID NLM: 8309603
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
17
11
2020
revised:
28
01
2021
accepted:
18
02
2021
pubmed:
21
3
2021
medline:
25
8
2021
entrez:
20
3
2021
Statut:
ppublish
Résumé
The nutritional risk screening (NRS 2002) is a validated screening tool for malnutrition. This study aims to investigate the prognostic value of the NRS 2002 and its individual components regarding long-term mortality and adverse outcomes in a well-characterized cohort of medical inpatients. We performed a 5-year follow-up investigation of patients included in the investigator-initiated, prospective, randomized controlled multicenter EFFORT trial that evaluated the effects of individualized nutritional intervention vs. standard hospital food. We used multivariable cox regression analyses adjusted for randomisation arm, study centre, comorbidities and main admission diagnosis to investigate associations between NRS 2002 total scores at time of hospital admission and several long-term outcomes. We had confirmed mortality data over the mean follow-up time of 3.2 years in 1874 from the initial cohort of 2028 EFFORT patients. Mortality showed a step-wise increase in patients with NRS 3 (289/565 [51.2%]) and NRS 4 (355/717 [49.6%]) to 59.5% (353/593) in patient with NRS≥5 corresponding to an adjusted Hazard Ratio (HR) of 1.28 (95%CI 1.15 to 1.42, p ≤ 0.001) for mortality after one year and 1.13 (95%CI 1.05 to 1.23, p = 0.002) for the overall time period. All individual components of NRS including disease severity, food intake, weight loss and BMI provided prognostic information regarding long-term mortality risk. Nutritional risk mirrored by a NRS 2002 total score is a strong and independent predictor of long-term mortality and morbidity in polymorbid medical inpatients particularly in patients with high nutritional risk with an NRS ≥5 points.
Sections du résumé
BACKGROUND AND AIMS
The nutritional risk screening (NRS 2002) is a validated screening tool for malnutrition. This study aims to investigate the prognostic value of the NRS 2002 and its individual components regarding long-term mortality and adverse outcomes in a well-characterized cohort of medical inpatients.
METHODS
We performed a 5-year follow-up investigation of patients included in the investigator-initiated, prospective, randomized controlled multicenter EFFORT trial that evaluated the effects of individualized nutritional intervention vs. standard hospital food. We used multivariable cox regression analyses adjusted for randomisation arm, study centre, comorbidities and main admission diagnosis to investigate associations between NRS 2002 total scores at time of hospital admission and several long-term outcomes.
RESULTS
We had confirmed mortality data over the mean follow-up time of 3.2 years in 1874 from the initial cohort of 2028 EFFORT patients. Mortality showed a step-wise increase in patients with NRS 3 (289/565 [51.2%]) and NRS 4 (355/717 [49.6%]) to 59.5% (353/593) in patient with NRS≥5 corresponding to an adjusted Hazard Ratio (HR) of 1.28 (95%CI 1.15 to 1.42, p ≤ 0.001) for mortality after one year and 1.13 (95%CI 1.05 to 1.23, p = 0.002) for the overall time period. All individual components of NRS including disease severity, food intake, weight loss and BMI provided prognostic information regarding long-term mortality risk.
CONCLUSION
Nutritional risk mirrored by a NRS 2002 total score is a strong and independent predictor of long-term mortality and morbidity in polymorbid medical inpatients particularly in patients with high nutritional risk with an NRS ≥5 points.
Identifiants
pubmed: 33743290
pii: S0261-5614(21)00120-5
doi: 10.1016/j.clnu.2021.02.032
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1546-1554Investigateurs
Rebecca Fehr
(R)
Valerie Baechli
(V)
Martina Geiser
(M)
Manuela Deiss
(M)
Filomena Gomes
(F)
Alexander Kutz
(A)
Thomas Bregenzer
(T)
Claus Hoess
(C)
Vojtech Pavlicek
(V)
Sarah Schmid
(S)
Stefan Bilz
(S)
Sarah Sigrist
(S)
Michael Braendle
(M)
Carmen Benz
(C)
Christoph Henzen
(C)
Silvia Mattmann
(S)
Robert Thomann
(R)
Claudia Brand
(C)
Jonas Rutishauser
(J)
Drahomir Aujesky
(D)
Nicolas Rodondi
(N)
Jacques Donzé
(J)
Informations de copyright
Copyright © 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.