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OBJECTIVE: Malnutrition is related to increased morbidity, mortality, and costs. NRS-2002 is a practical malnutrition risk (MR) screening tool approved by the European Society for Clinical Nutrition and Metabolism (ESPEN) for inpatients. We aimed to reveal the inpatient MR using NRS-2002, and to examine the relationship between MR and in-hospital mortality. PATIENTS AND METHODS: The results of inpatient nutritional screening in a tertiary referral center university hospital were retrospectively analyzed. The NRS-2002 test was used for defining MR. Comorbidities, initial and follow-up anthropometric data, NRS-2002 score, food intake, weight status, and laboratory analysis were examined. In-hospital mortality was noted. RESULTS: Data from 5,999 patients were evaluated. On admission, 49.8% of the patients had MR, and 17.3% had severe MR (sMR). MR-sMR was higher in geriatric patients (62.0-28.5%). Those with dementia had the highest MR (71%), followed by stroke (66%) and malignancy (62%). Age and serum C-reactive protein (CRP) were higher, and body weight, BMI, serum albumin, and creatinine were lower in patients with MR. Multivariate analysis showed that age, albumin, CRP, congestive heart failure (CHF), malignancy, dementia, and stroke were independently associated with MR. The overall mortality rate during hospitalization was 7.9%. MR was associated with mortality regardless of serum CRP, albumin, body mass index (BMI), and age. Half of the patients received nutritional treatment (NT). NT resulted in preserved or increased body weight and albumin levels among patients and the geriatric group with MR. CONCLUSIONS: AMR revealed that NRS2002 is positive in approximately half of the hospitalized patients, which is associated with in-hospital mortality independent of the underlying diseases. NT is related to weight gain and increased serum albumin. [ABSTRACT FROM AUTHOR]

Özlem Deligöz, Osman Ekinci University of Health Sciences, Haydarpa&scedil;a Numune Training and Research Hospital, Istanbul, TurkeyCorrespondence: Özlem Deligöz, University of Health Sciences, Haydarpa&scedil;a Numune Training and Research Hospital, Istanbul, Turkey, Email ozlem.deligoz@gmail.comObjective: Malnutrition is very commonly encountered in palliative care centers (PCC), especially in geriatric patients. It is known that development of malnutrition increases morbidity and mortality. In this study, we aimed to investigate the effectiveness of commonly used nutritional assessment parameters in predicting prognosis in geriatric patients diagnosed in PCC with malnutrition.Methods: Our study included 1451 patients aged ≥ 65 years, who were diagnosed with malnutrition in PCC between 2016– 2020 and did not yet start receiving nutritional support. Demographic data, comorbidities, The Nutritional Risk Screening 2002 (NRS-2002), body mass index (BMI), albumin, prealbumin and C-reactive protein (CRP) values of the patients were recorded. Prognostic course was evaluated by dividing the patients into 3 groups, namely mortal patients during PCC follow-up, patients transferred from PCC to Intensive Care (ICU) and patients discharged to home from PCC.Results: Logistic Regression analysis showed that low albumin levels affected transfer to ICU (P< 0.05). Elevated NRS-2002 and low albumin and prealbumin levels were found to be factors affecting mortality (P< 0.05). Areas under the ROC Curve were calculated to attain patients’ differential diagnosis. The area under the ROC Curve of low albumin in patients transferred to ICU was found to be significant (P< 0.05). In the differential diagnosis of patients with mortal course, the area under the ROC Curve of low albumin and prealbumin and high CRP was found to be significant (P< 0.05).Conclusion: We found that BMI had no prognostic predictive effects in geriatric PCC patients with malnutrition. We concluded that NRS-2002 and high CRP and low albumin and prealbumin can be used to predict mortality. In addition, we found that low albumin indicates a poor prognosis and predicts patients to be transferred to ICU.Keywords: NRS-2002, malnutrition, albumin, prealbumin, CRP, mortality

To compare the hospitalization duration and mortality with the first day nutritional status of the patients who were hospitalized in intensive care unit of internal medicine department. The files of patients admitted to the ICU between 01-January-2017 and 30-June-2017 were retrospectively reviewed. Those who were not eligible for study in the selected files were later handed off. The remaining patients (169 patients) were evaluated for age, sex, stay in intensive care unit, APACHE2 and Glasgow scores, outcomes (exitus or discharge), NRS-2002 values in day of hospitalization, glucose, creatinine, albumin, White Blood Cell, hematocrit, thrombocyte, C-reactive protein and thyroid stimulating hormone (TSH) values were recorded. In addition, patients need for mechanical ventilation and underlying diseases (Chronic renal failure, cancer, sepsis, etc.) were recorded. The mean NRS-2002 score of the whole group was 4.28±0.90. The mean NRS-2002 score of discharged patients was 3.98±0.80 while the mean NRS-2002 score was 4.71±0.86 (p [Med-Science 2019; 8(2.000): 263-7]

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We aimed to provide insight into nutritional and clinical indicators of malnutrition risk and their influence on two-year mortality and re-hospitalization rate among patients hospitalized in internal clinic departments in the tertiary hospital in Croatia. Initially, data on 346 participants were obtained, while 218 of them where followed-up two years later. At baseline, the majority of participants were old and polymorbid (62.1% suffered from arterial hypertension, 29.5% from cancer, and 29.2% from diabetes). Even apparently presenting with satisfying anthropometric indices, 38.4% of them were at-risk for malnutrition when screened with the Nutritional Risk Screening-2002 (NRS-2002) questionnaire (NRS-2002 ≥ 3). More importantly, only 15.3% of all participants were prescribed an oral nutritional supplement during hospitalization. Those that were at-risk for malnutrition suffered significantly more often from cancer (54.9% vs. 20.6%; p < 0.001) and died more often in the follow-up period (42.7% vs. 23.5%; p < 0.003). Their anthropometric indices were generally normal and contradictory 46.3% were overweight and obese (body mass index (BMI) > 25 kg/m2). Only 36.6% of nutritionally endangered participants used an oral supplement in the follow-up period. NRS-2002 ≥ 3 correlated with anthropometric indices, glomerular filtration rate, age, and length of the initial hospital stay. Unlike other studies, NRS-2002 ≥ 3 was not an independent predictor of mortality and re-hospitalizations; other clinical, rather than nutritional parameters proved to be better predictors. Patients in our hospital are neither adequately nutritionally assessed nor managed. There is an urgent need to develop strategies to prevent, identify, and treat malnutrition in our hospital and post-discharge.

Introduction: Malnutrition is a common dysfunction in critically ill patients admitted to intensive care unit (ICU), and the assessment of nutrition in the ICU poses a unique challenge for clinicians. The aim of our study is to investigate the performance of nutritional screening tools in predicting hospital, 28-day and 3-month mortality in critically ill patients admitted to the ICU due to respiratory failure (RF). In this report; we aimed to share the 1-month preliminary results of our study and the 28-day mortality data with you. Materials and Methods: To the first 1-month preliminary report of our prospective observational study; all adult patients (≥18 years old) who applied to the ICUs with RF and stayed in the ICU for more than 72 hours were included, with the decision of the ethics committee numbered 2012- KAEK-15/2627. Multiple logistic regression analysis and relative risk for mortality prediction performance of the instruments were used to test the complementarity between mNUTRIC and NRS-2002. Results: One hundred twenty patients were evaluated. The outcomes of the patients according to 1-month mortality are given in Table 1. In patients included in the study, 50% (p=0.453) by NRS-2002, 71.7% (p<0.001) by mNUTRIC, and 40.8% (p=0.046) by mNUTRIC + NRS-2002 (score ≥5) were found to be at high nutritional risk. The risk of 28-day mortality was 8.5 times higher in patients with mNUTRIC ≥5, one times in patients with NRS-2002 ≥5, and 1.5 times more in patients with mNUTRIC + NRS-2002 ≥5 (Table 2). mNUTRIC AUC 0.782; NRS-2002 AUC 0.521 and mNUTRIC + NRS-2002 AUC 0.636 were detected (Figure 1). Conclusion: There is no specific study in the literature on nutritional risk screening of critically ill patients with RF. It is not known whether the sensitivity of these scores changes according to the type of RF. The mNUTRIC score is statistically superior to the use of NRS-2002 and the combined two scores in predicting 28-day mortality in patients admitted to the ICU with RF. [ABSTRACT FROM AUTHOR]

Summary Background & aims Hospitalized patients should be screened for nutritional risk and adequately managed. Being nutritionally ‘at-risk’ increases in-hospital mortality, length of stay (LOS) and costs, but the impact on actual costs has seldom been assessed. We aimed to determine nutritional risk screening and management in a Swiss university hospital. The impact of being nutritionally ‘at-risk’ on in-hospital mortality, LOS and costs was also assessed. Methods Retrospective analysis of administrative data for years 2013 and 2014 from the department of internal medicine of the Lausanne university hospital (8541 hospitalizations, mean age 72.8 ± 16.5 years, 50.4% women). Being nutritionally ‘at-risk’ was defined as a Nutritional risk screening-2002 score ≥ 3 and nutritional managements were collected from medical records. Results Screening increased from 16.5% in 2013 to 41.9% in 2014 (p < 0.001), while prevalence of ‘at-risk’ patients remained stable (64.6% in 2013 and 62.7% in 2014, p = 0.37). Prevalence of ‘at-risk’ patients was highest in patients with cancer (85.3% in 2013 and 70.2% in 2014) and lowest in patients with disease of skin (42% in 2013 and 44.8% in 2014). Less than half of patients ‘at-risk’ received any nutritional management, and this value decreased between 2013 and 2014 (46.9% vs. 40.3%, p < 0.05). After multivariate adjustment, ‘at-risk’ patients had a 3.7-fold (95% confidence interval: 1.91; 7.03) higher in-hospital mortality and higher costs (excess 5642.25 ± 1479.80 CHF in 2013 and 5529.52 ± 847.02 CHF in 2014, p < 0.001) than ‘not at-risk’ patients, while no difference was found for LOS. Conclusion Despite an improvement in screening, management of nutritionally ‘at-risk’ patients is not totally covered yet. Being nutritionally ‘at-risk’ affects three in every five patients and is associated with increased mortality and hospitalization costs. [ABSTRACT FROM AUTHOR]

We aimed to provide insight into nutritional and clinical indicators of malnutrition risk and their influence on two-year mortality and re-hospitalization rate among patients hospitalized in internal clinic departments in the tertiary hospital in Croatia. Initially, data on 346 participants were obtained, while 218 of them where followed-up two years later. At baseline, the majority of participants were old and polymorbid (62.1% suffered from arterial hypertension, 29.5% from cancer, and 29.2% from diabetes). Even apparently presenting with satisfying anthropometric indices, 38.4% of them were at-risk for malnutrition when screened with the Nutritional Risk Screening-2002 (NRS-2002) questionnaire (NRS-2002 ≥ 3). More importantly, only 15.3% of all participants were prescribed an oral nutritional supplement during hospitalization. Those that were at-risk for malnutrition suffered significantly more often from cancer (54.9% vs. 20.6%; p < 0.001) and died more often in the follow-up period (42.7% vs. 23.5%; p < 0.003). Their anthropometric indices were generally normal and contradictory 46.3% were overweight and obese (body mass index (BMI) > 25 kg/m2). Only 36.6% of nutritionally endangered participants used an oral supplement in the follow-up period. NRS-2002 ≥ 3 correlated with anthropometric indices, glomerular filtration rate, age, and length of the initial hospital stay. Unlike other studies, NRS-2002 ≥ 3 was not an independent predictor of mortality and re-hospitalizations; other clinical, rather than nutritional parameters proved to be better predictors. Patients in our hospital are neither adequately nutritionally assessed nor managed. There is an urgent need to develop strategies to prevent, identify, and treat malnutrition in our hospital and post-discharge. [ABSTRACT FROM AUTHOR]

This study aimed to compare the prognostic value of malnutrition and sarcopenia for mortality in old adults over 80 years. A prospective analysis was performed in 427 hospitalized old adults. Anthropometric measures and biochemical parameters were carried out for each patient. Sarcopenia was defined according to the revised consensus definition of the European Working Group on Sarcopenia in Older People (EWGSOP2). Malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. Mortality data were available for up to 32 months of follow-up. The overall prevalence of sarcopenia and malnutrition was 35.1% and 19.4%, respectively. The percentage of coexistence of sarcopenia and malnutrition was 12.2%. Of the 427 participants, 83 deaths were reported during the mean follow-up periods of 24.9 months. Compared with non-sarcopenic subjects with well-nutrition, sarcopenic subjects with well-nutrition and non-sarcopenic subjects with well-nutrition had higher mortality risk (Hazard Ratio (HR), 2.36; 95% confidence interval (CI), 1.31–4.24, P < 0.001; HR, 4.33; 95% CI, 2.12–8.85, P = 0.004; respectively). The patients who coexisted with sarcopenia and malnutrition had the highest risk of mortality (HR, 7.31; 95% CI, 4.21–12.69, P < 0.001). Both sarcopenia and malnutrition could predict mortality separately. Still, from the components of the Cox regression multivariate models, the malnutrition was one of the independent factors influencing the death, sarcopenia was not. When malnutrition and sarcopenia were compared together in a longitude cohort, malnutrition was an independent risk factor for mortality, while sarcopenia was not. The coexistence of malnutrition and sarcopenia showed a synergistically accumulated risk for death. • When compared in a longitude cohort, malnutrition was an independent risk factor for mortality, while sarcopenia was not. • The coexistence of sarcopenia and malnutrition was common in hospitalized old adults over 80 years • The coexistence of malnutrition and sarcopenia showed a synergistically accumulated risk for mortality. • The patients coexisted with sarcopenia and malnutrition had more than seven-fold mortality risk. [ABSTRACT FROM AUTHOR]