Nutritional Risk Screening with NRS2002 among Hospitalized Cancer Patients in China

Objective The Nutritional Risk Screening 2002(NRS 2002)was used to assess the nutritional risk of hospitalized oncology patients in China.This study explored the factors affecting the risk of nutrition to provide a scientific basis for the assessment and treatment of malnutrition in oncology patients.Methods We used the NRS 2002 to evaluate the nutritional risk in 48,831 hospitalized cancer patients.Descriptive statistical methods were used to describe the general patient information.A Chi-squared test was applied to analyze the relationship between NRS 2002 scores and different demographic characteristics,and the NRS 2002 scores of cancer patients with different characteristics were compared by one-way ANOVA.Results Among 48,831 patients,43.3%were women and 57.7%were men,and 36.5%(17,802)of patients were at risk of nutrition(score≥3).The NRS 2002 score was the highest in leukemia patients(2.93±1.28).A one-way ANOVA revealed that the differences in NRS 2002 scores among patients of different gender,ages,TNM stages,education levels,occupations and areas of residence were statistically significant(P<0.001).Male patients had slightly higher NRS 2002 scores than females(2.33 vs.2.17).The lowest NRS 2002 scores were in patients aged 45-59(2.00±1.26)years and the highest scores were in patients aged≥70(2.76±1.43)years.The NRS 2002 score of patients receiving surgery was the highest(2.45±1.41),and patients receiving surgery plus radiotherapy/chemotherapy was the lowest(2.00±1.26).The risk of nutrition was highest in patients who were farmers(2.34±1.37 scores)and lowest in office staff(2.15±1.32 scores).Patients living in rural areas had the highest risk of nutrition(2.32±1.37 scores).There were significant differences in the NRS 2002 scores for different cancer sub-types for different ethnic groups(P<0.05),except for Zhuang individuals(P=0.124).The risk of nutrition was highest in Uyghur patients(3.35±1.33 scores)and lowest in Mongolians(2.04±1.37 scores).Conclusion More attention should be paid to people at high risk of nutrition,such as elderly patients,patients with a high TNM stage,patients receiving surgical treatment,and patients living in rural areas.Active nutritional interventions should be carried out to improve the nutritional status of malnourished patients.

Nutritional status and prognostic factors for mortality in patients admitted to emergency department observation units:a national multi-center study in China

BACKGROUND:Nutritional risk is common among patients admitted to the emergency department and is associated with adverse clinical outcomes.Despite its large population,few comprehensive studies have been conducted in China concerning the nutritional status of patients admitted to emergency department observation units(EDOUs).METHODS:Patients admitted to EDOUs of 90 tertiary hospitals in China between June 2020 and December 2020 were enrolled.Demographic information,laboratory parameters,nutritional support therapies,and 28-day mortality were recorded.Risk factors for mortality were examined using multi-variateadjusted logistic regression analysis.Receiver operating characteristic(ROC)curves for each predictor of mortality were plotted,and the area under the ROC(AUROC)curves was compared.RESULTS:A total of 2,005 eligible patients were finally enrolled.At the 28-day follow-up,1,911 patients survived,and 94 died.The group with a Nutritional Risk Screening 2002(NRS 2002)score of 3-4 points was the largest(52.01%).The number of patients receiving oral nutritional supplements,enteral nutrition(EN),parenteral nutrition(PN),and the combination of EN and PN was 425,314,853,and 413,respectively.Among the total,77.55%of patients had nutritional risk(NRS 2002≥3).The proportion of patients with high nutritional risk(NRS2002≥5)in the age group>80 years was significantly higher than that in the age group 66-80 years(29.00%vs.23.93%,P=0.032),but not significantly higher than that in the age group 18-65 years(29.00%vs.26.54%,P=0.449).Logistic regression analysis revealed that heart failure(odds ratio[OR]1.856,95%confidence interval[CI]1.087-3.167,P=0.023),consciousness(OR 2.967,95%CI 1.894-4.648,P<0.001),Acute Physiology and Chronic Health Evaluation II(APACHE II)score(OR 1.037,95%CI 1.017-1.058,P<0.001),NRS 2002 score(OR 1.286,95%CI 1.115-1.483,P=0.001),and Mini Nutritional Assessment-Short Form score(OR 0.946,95%CI 0.898-0.997,P=0.039)were all independent risk factors for 28-day mortality.APACHE II and NRS 2002 scores were superior to other predictors according to the comparison of AUROC.CONCLUSIONS:Nutritional risk is prevalent among older patients in EDOUs in China.APACHE II and NRS 2002 scores are important risk factors for mortality in patients admitted to the EDOU.Timely and appropriate nutritional screening and support measures are critical to reduce patients’length of hospital stay and mortality.

The Role of the PNI and NLR in Nutritional Risk Screening and Assessment of Gastric Cancer Patients

Background The use of nutritional risk screening and assessment is becoming increasingly common in cancer patients.The Nutritional Risk Screening 2002(NRS 2002)is a nutritional risk screening programe with good utility.The patient generated-subjective global assessment(PG-SGA)is a method used to assess the nutritional status of cancer patients.The prognostic nutritional index(PNI)and neutrophil to lymphocyte ratio(NLR)are considered to be predictors of the prognosis following treatment for patients with a variety of cancers.However,the relationship between the PNI and NLR in the nutritional screening and assessment in patients with gastric cancer is unknown.Methods A retrospective analysis was performed on 378 patients with gastric cancer who underwent surgery at the First Affiliated Hospital of Guangxi Medical University from August 2019 to December 2020.NRS 2002 and PG-SGA were performed within 24 hours of admission,and indicators such as the serum albumin level,body mass index(BMI),PNI and NLR were measured.Results In the grouping based on the NRS2002,patients in the positive group(NRS 2002≥3)had a higher platelet value,a higher median NLR,and a lower PNI than those in the negative group(NRS 2002<3)(295.50±118.49×10^(9)/L vs.269.36±93.52×10^(9)/L,2.38 vs.1.77,42.36±5.96 vs.46.64±4.29).Based on the PG-SGA grouping,the serum albumin level and lymphocyte count were highest in the mild group(PG-SGA:score 2-3),(36.94±3.51 g/L and 1.91±0.7610^(9)/L)and lowest within the severe group(PG SGA score≥9)(34.09±4.18 g/L and 1.51±0.6410^(9)/L).The BMI was highest in the mild group(23.35±3.00 kg/m^(2))and lowest in the severe group(20.63±2.97 kg/m^(2)),and the PNI was also highest in the mild group(46.50±5.17)and lowest in the severe group(41.64±5.53).However,the NLR was lowest in the mild group(median 1.91)and highest in the severe group(median 2.44).Conclusion The PNI and NLR in gastric cancer patients are closely related to the results of the nutritional risk screening and assessment,suggesting that they may be useful to guide the nutritional interventions for gastric cancer patients.

Relationship of the preoperative NRS 2002 score,PG-SGA score,and serum indices with postoperative complications in patients with gastric cancer

Objective To examine the utility of the Nutrition Risk Screening 2002(NRS 2002),Patient-Generated Subjective Global Assessment(PG-SGA)and serum factors for the preoperative evaluation of gastric cancer patients.Methods We examined 181 gastric cancer patients treated at the First Affiliated Hospital of Guangxi Medical University from January 2015 to January 2018.Nutritional assessments were administered within 48 h of admission.The body mass index(BMI)and serum factors were measured,and information on preoperative nutritional support and postoperative complications was recorded.Results Both the NRS 2002 and PG-SGA had positive correlations with age(P<0.05),and negative correlations with albumin,prealbumin,transferrin,hemoglobin,BMI,and bodyweight(P<0.05).The NRS 2002 and PG-SGA scores were positively correlated with each other(r=0.683,P<0.01),but had poor consistency(κ=0.357,P<0.01).During the preoperative period,33.2%of patients received nutritional support,mainly enteral nutrition.The nutritional risk group(NRS 2002≥3)received more support than the group without nutritional risk(NRS 2002<3;P<0.05).Patients with nutritional risk or malnutrition who received preoperative nutritional support had fewer postoperative complications than unsupported patients.The overall rate of complications was 12.2%,and the rate of severe complications(gradeⅢor above)was 5.5%.The malnutrition and nutritional risk groups had higher rates of severe complications.Conclusions The combined application of the NRS 2002,PG-SGA,BMI,and serum nutritional indices was useful for the nutritional screening and assessment of preoperative gastric cancer patients.The NRS 2002 and PG-SGA provided guidance on the need for nutritional support during the preoperative period.

The Values of the Prognostic Nutrition Index and the Patient Generated-Subjective Global Assessment during the Nutritional Assessment of Patients with Gastrointestinal Tumors

Objective To compare the value and consistency among the Patient Generated-Subjective Global Assessment(PG-SGA)and the Prognostic Nutrition Index(PNI)for assessing nutritional status in gastrointestinal tumor patients.Methods 251 patients from gastric cancer surgical ward from January 2019 to January 2020 were recruited through convenience sampling in this respective study.Nutritional screening and assessment were conducted for 251 gastrointestinal tumor patients using the nutritional risk screening 2002(NRS 2002)PG-SGA,and the PNI.PNI was calculated using the serum albumin level and the total lymphocyte count obtained from the patients’routine laboratory examination when they were admitted to the hospital.The receiver operating characteristic(ROC)of the PG SGA and the PNI were plotted with the NRS 2002 used as the gold standard,and the diagnostic value of the PG-SGA and PNI was reflected by the area under the curve(AUC),sensitivity,specificity and Youden index.We then determined the optimal cut-off for the PNI and tested the consistency of the PG-SGA and PNI.Results The optimal cut-off point for the PNI was calculated to be 50.78.The AUC of the PG-SGA was 0.908(95%CI 0.871-0.944).The sensitivity was 89.9%,specificity was 76.2%and the Youden index was 0.661.The AUC of the PNI was 0.594(95%CI 0.516-0.572).The sensitivity was 73.8%,specificity was 44.3%and the Youden index was 0.181.In the consistency test,the kappa value was 0.838(P<0.001).Conclusion The PNI is of limited value for assessing malnutrition,although it did have good consistency with the PG-SGA.The combination of the PNI and PG-SGA can be used for diagnosing assessing malnutrition in clinical practice.

Malnutrition as a predictor of prolonged length of hospital stay in patients with gynecologic malignancy: A comparative analysis

Objective To explore the consistency of the Patient-generated Subjective Global Assessment(PG-SGA)and Nutritional Risk Screening-2002(NRS-2002)for nutritional evaluation of patients with gynecologic malignancy and their predictive effect on the length of hospital stay(LOS).Methods We recruited 147 hospitalized patients with gynecologic malignancy from Nanfang Hospital in 2017.Their nutritional status was assessed using the PG-SGA and NRS-2002.The consistency between the two assessments was compared via the Kappa test.The relationship between malnutrition and LOS was analyzed using crosstabs and Spearman’s correlation.Results The PG-SGA demonstrated that 66.7%and 54.4%of patients scoring≥2 and≥4 were malnourished,respectively.Furthermore,the NRS-2002 indicated that 55.8%of patients were at nutritional risk.Patients with ovarian cancer had a relatively high incidence of malnutrition.However,this was only significant for patients who scored≥4 in the PG-SGA(P=0.001 and P=0.019 for endometrial carcinoma and cervical cancer,respectively).The PG-SGA and NRS-2002 showed good consistency in evaluating the nutritional status of patients with gynecologic malignancy(0.689,0.643 for PG-SGA score≥2,score≥4 and NRS-2002,respectively).Both the scores of PG-SGA and NRS-2002 were positively correlated with LOS.Furthermore,prolonged LOS was higher in patients with malnutrition than in those with adequate nutrition.Conclusion The PG-SGA and NRS-2002 shared a good consistency in evaluating the nutritional status of patients with gynecologic malignancy.Both assessments could be used as predictors of LOS.