Low serum albumin levels resulting from inflammation-induced capillary leakage or disease-related anorexia during acute illness are associated with poor outcomes. We investigated the relationship of ...nutritional status and inflammation with low serum albumin levels and 30-day mortality in a large cohort.
We prospectively enrolled adult patients in the medical emergency department of a Swiss tertiary care center and investigated associations of C-reactive protein (CRP) and Nutritional Risk Screening 2002 as markers of inflammation and poor nutritional status, respectively, with low serum albumin levels and mortality using multivariate regression analyses.
Among the 2465 patients, 1019 (41%) had low serum albumin levels (<34 g/L), 619 (25.1%) had increased nutritional risk (Nutritional Risk Screening 2002 ≥3), and 1086 (44.1%) had CRP values >20 mg/L. Multivariate analyses adjusted for age, gender, diagnosis, and comorbidities revealed elevated CRP values (adjusted odds ratio OR 10.51, 95% confidence interval, 7.51-14.72, P <.001) and increased malnutrition risk (adjusted OR 2.87, 95% confidence interval, 1.98-4.15, P <.001) to be associated with low serum albumin levels, even adjusting for both parameters. Low serum albumin levels, elevated CRP values, and increased nutritional risk independently predicted 30-day mortality, with areas under the curve of 0.77, 0.70, and 0.75, respectively. Combination of these 3 parameters showed an area under the curve of 0.82 to predict mortality.
Elevated parameters of inflammation and high nutritional risk were independently associated with hypoalbuminemia. All 3 parameters independently predicted mortality. Combining them during initial evaluation of patients in emergency departments facilitates mortality risk stratification.
Various risk factors for developing severe coronavirus disease 2019 (COVID-19) have been reported. However, studies on the nutritional-related risk factors are limited. In this study, we investigated ...the effects of serum zinc deficiency on the severity of COVID-19.
The study included a total of 60 COVID-19 patients who were admitted to Tsuyama Chuo Hospital between March 2020 and April 2021. We divided the patients into two categories based on serum levels of zinc (normal and latent zinc deficiency vs. zinc deficiency <60 μg/dL) at the time of diagnosis. Severity of COVID-19 was defined as the most exaggerated disease status during admission. The associations between serum zinc deficiency and the severity of COVID-19 were examined using a logistic regression model adjusted for potential confounders.
Patients who required oxygen therapy had a higher prevalence of comorbidities and poorer nutritional status, including zinc deficiency, than those who did not require oxygen therapy. Zinc deficiency was associated with an increased risk of COVID-19 severity, with an adjusted odds ratio of 7.29 (95% confidence interval: 1.70–31.18). This result remained significant in the sensitivity analyses conducted after adjusting for patient background factors.
Zinc deficiency at the time of COVID-19 diagnosis is an independent risk factor for severe disease. Our findings need to be validated in external studies.
Deterioration of nutritional status during hospitalization in patients with chronic heart failure increases mortality. Whether nutritional support during hospitalization reduces these risks, or on ...the contrary, may be harmful due to an increase in salt and fluid intake, remains unclear.
The purpose of this trial was to study the effect of nutritional support on mortality in patients hospitalized with chronic heart failure who are at nutritional risk.
A total of 645 patients with chronic heart failure (36% n = 234 with acute decompensation) participated in the investigator-initiated, open-label EFFORT (Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients) trial. Patients were randomized to protocol-guided individualized nutritional support to reach energy, protein, and micronutrient goals (intervention group) or standard hospital food (control group). The primary endpoint was all-cause mortality at 30 days.
Mortality over 180 days increased with higher severity of malnutrition (odds ratio per 1-point increase in Nutritional Risk Screening 2002 score: 1.65; 95% confidence interval CI: 1.21 to 2.24; p = 0.001). By 30 days, 27 of 321 intervention group patients (8.4%) died, compared with 48 of 324 (14.8%) control group patients (odds ratio: 0.44; 95% CI: 0.26 to 0.75; p = 0.002). Patients at high nutritional risk showed the most benefit from nutritional support. Mortality effects remained significant at 180-day follow-up. Intervention group patients also had a lower risk for major cardiovascular events at 30 days (17.4% vs. 26.9%; odds ratio: 0.50; 95% CI: 0.34 to 0.75; p = 0.001).
Among hospitalized patients with chronic heart failure at high nutritional risk, individualized nutritional support reduced the risk for mortality and major cardiovascular events compared with standard hospital food. These data support malnutrition screening upon hospital admission followed by an individualized nutritional support strategy in this vulnerable patient population. (Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial EFFORT; NCT02517476)
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Nutritional Risk Screening and Assessment Reber, Emilie; Gomes, Filomena; Vasiloglou, Maria F ...
Journal of clinical medicine,
07/2019, Volume:
8, Issue:
7
Journal Article
Peer reviewed
Open access
Malnutrition is an independent risk factor that negatively influences patients' clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of ...malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support. Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients' nutritional condition. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients.
Nutritional impairments may negatively impact different outcomes, including survival, in patients with thoracic malignancies. Despite this, a low number of patients are screened for nutritional risk ...and referred to an appropriate service. The aim of this study is to evaluate the feasibility of an Assess-Advise-Refer approach to implementing the engagement of the medical staff to refer patients at nutritional risk to a dedicated dietician.
Thoracic oncologists were trained to: i) administer the Nutritional Risk Screening (NRS-2002) tool to the patients during the first oncological evaluation to identify the nutritional risk, ii) advise patients about the importance of nutrition in cancer, and iii) refer patients at nutritional risk to the dedicated dietetic service.
Between July 2022 and February 2023, 40% of patients scheduled for a first oncological evaluation received nutritional screening from oncologist. All the screened patients were advised about the importance of nutritional aspects during cancer care. Overall, seven patients were detected at nutritional risk and referred to the dietetic service. Additionally, other four patients were referred to the dietitian upon their request.
Whereas advice and referral appear to be better implemented, nutritional screening needs to be more integrated into the clinical practice routine.
Although malnutrition is associated with poor prognosis in several diseases, its prognostic impact in patients with heart failure (HF) and secondary mitral regurgitation (SMR) is not understood.
The ...purpose of this study was to assess the prevalence and impact of malnutrition in HF patients with severe SMR randomized to transcatheter edge-to-edge repair (TEER) with the MitraClip plus guideline-directed medical therapy (GDMT) vs GDMT alone in the COAPT trial.
Baseline malnutrition risk was calculated using the validated geriatric nutritional risk index (GNRI) score. Patients were categorized as having “malnutrition” (GNRI ≤98) vs “no malnutrition” (GNRI >98). Outcomes were assessed through 4 years. The primary endpoint of interest was all-cause mortality.
Among 552 patients, median baseline GNRI was 109 (IQR: 101-116); 94 (17.0%) had malnutrition. All-cause mortality at 4 years was greater in patients with vs those without malnutrition (68.3% vs 52.8%; P = 0.001). Using multivariable analysis, both baseline malnutrition (adjusted-HR adj-HR: 1.37; 95% CI: 1.03-1.82; P = 0.03) and randomization to TEER plus GDMT compared with GDMT alone (adj-HR: 0.65; 95% CI: 0.51-0.82; P = 0.0003) were independent predictors of 4-year mortality. In contrast, GNRI was unrelated to the 4-year rate of heart failure hospitalization (HFH), although TEER treatment reduced HFH (adj-HR: 0.46; 95% CI: 0.36-0.56). The reductions in death (adj-Pinteraction = 0.46) and HFH (adj-Pinteraction = 0.67) with TEER were consistent in patients with and without malnutrition.
Malnutrition was present in 1 of 6 patients with HF and severe SMR enrolled in COAPT and was independently associated with increased 4-year mortality (but not HFH). TEER reduced mortality and HFH in patients with and without malnutrition. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation The COAPT Trial and COAPT CAS COAPT; NCT01626079)
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Malnutrition is a prevalent complication in patients on maintenance hemodialysis. Nutritional screening tools may be useful to identify those patients at nutritional risk from among hundreds of ...hemodialysis patients in a large facility.
We tested several simplified nutritional screening tools on hemodialysis patients to validate the potential application of the tools.
The simplified nutritional screening tools were chosen from references published between 1985 and 2005. Nutritional assessments, including history taking, and anthropometric and biochemical measurements were performed on 422 hemodialysis patients. These results were applied to obtain the score of each nutritional screening tool and the malnutrition-inflammation score (MIS), a comprehensive nutritional assessment tool, as the reference standard. The usefulness of each nutritional screening tool for identifying nutritional risk was assessed by comparison with the MIS value and various individual nutritional measures.
Five reliable nutritional screening tools were found by the literature search. Among them, the geriatric nutritional risk index (GNRI) was considered to be the most accurate in identifying hemodialysis patients at nutritional risk, because the area under the receiver operating characteristic curve generated with the MIS value was the largest. The GNRI showed a significantly negative correlation with the MIS (r = −0.67, P < 0.0001), and the most accurate GNRI cutoff to identify a malnourished patient according to the MIS was <91.2. The GNRI’s sensitivity, specificity, and accuracy of <91.2 in predicting malnutrition according to the MIS were 0.730, 0.819, and 0.787, respectively.
The GNRI was the simplest and most accurate risk index for identifying hemodialysis patients at nutritional risk according to the MIS.
The Global Leadership Initiative on Malnutrition (GLIM) proposed a two-step approach for the malnutrition diagnosis: screening to identify “at risk” patients by any validated nutritional screening ...tool (NST), followed by a detailed nutritional assessment for diagnosis and grading the severity of malnutrition. Since there are several validated NST, this study aimed to evaluate the complementarity of five NST to GLIM criteria for malnutrition diagnosis in a sample of hospitalized patients.
A secondary analysis of a longitudinal study. Data collection occurred within 48 h of hospital admission and included clinical, sociodemographic and nutritional data. We applied five tools for nutritional risk (NR) screening: Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Nutritional Risk in Emergency-2017 (NRE-2017), Nutritional Risk Screening - 2002 (NRS-2002), and Short Nutritional Assessment Questionnaire (SNAQ). GLIM criteria were applied to malnutrition diagnosis considering all five criteria. Patients were followed up until discharge to assess hospital length of stay (LOS) and in-hospital mortality and contacted six months post-discharge to assess hospital readmission and death. We calculated the sensitivity, specificity, predictive positive and negative values (PPV and NPV), and kappa. We grouped patients according to NR and malnutrition status in four categories i.e. NR(+)/GLIM(+) and investigated their associations with the clinical outcomes in regression models adjusted to the Charlson Comorbidity Index.
Among the 601 patients included (55.8 ± 14.8 years, 51.4% males), 41.6% were malnourished by GLIM criteria. The frequency of NR ranged from 24.0% (NRE-2017) to 35.8% (NRS-2002). MUST had the highest sensitivity (73.6%), NPV (83.6%) and PPV (93.4%). All NST presented specificity higher than 90%, except NRS-2002. The accuracy of NST ranged from 76.3% (SNAQ) to 86.8% (MUST). NR (+)/GLIM (+) by NRE-2017, MST, and MUST increased the risk of in-hospital mortality (HR ranged from 5.34 to 10.10). NR (+)/GLIM (+) increased the odds of LOS ≥10 days (RR between 2.11 and 3.01), readmission (RR between 1.51 and 1.80), and mortality six months after discharge (RR between 3.91 and 5.12), regardless of the NST applied.
MUST presented the highest metrics of accuracy in comparison to GLIM criteria and was an independent predictor of worse clinical outcomes when nutritional risk was combined to malnutrition diagnosis. So, risk screening by MUST is suggested as the first step of the GLIM approach.
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