BACKGROUND & AIMS:
OBJECTIVE:The aim of this study was to assess the prognostic value of different nutritional screening tools in patients undergoing cardiopulmonary bypass with regard to an adverse clinical course.
METHODS:This prospective cohort study analyzed 894 adult patients who underwent cardiopulmonary bypass. Patients were screened using four nutritional screening tools: Nutritional Risk Screening 2002 (NRS-2002), the Malnutrition Universal Screening Tool (MUST), the Mini-Nutritional Assessment (MNA), and the Short Nutritional Assessment Questionnaire (SNAQ). Nutritional status was assessed using the Subjective Global Assessment. In-hospital mortality, postoperative complications, length of stay in the intensive care unit, and length of hospitalization were analyzed.
RESULTS:The sensitivities of the SNAQ, MUST, and NRS-2002 to detect the malnutrition confirmed by the Subjective Global Assessment were 91.5%, 97.9%, and 38.3%, respectively, and the MNA showed a sensitivity of 81.8% for the elderly. Malnutrition detected by the SNAQ, MUST, and NRS-2002 was associated with postoperative complications (odds ratios [ORs] 1.75, 1.98, and 1.82, respectively) and a stay in the intensive care unit longer than 2 d (ORs 1.46, 1.56, and 2.8). Malnutrition as detected by the SNAQ and MUST was also associated with prolonged hospitalization (ORs 1.49 and 1.59). According to multivariate logistic regression analysis, postoperative complications were independently predicted by the European System for Cardiac Operative Risk Evaluation (OR 1.1, P < 0.0001), cardiopulmonary bypass time (OR 1.01, P < 0.0001), and malnutrition identified by the MUST (OR 1.2, P = 0.01).
CONCLUSION:The MUST independently predicts postoperative complications. The SNAQ and MUST have comparable accuracy in detecting malnutrition. Whether preoperative nutritional therapy would improve the outcome in malnourished patients needs to be studied.
背景与目标:
目的:本研究旨在评估不同营养筛查工具对体外循环不良患者的不良临床病程的预后价值。
方法:这项前瞻性队列研究分析了894例接受了体外循环的成年患者。使用四种营养筛查工具对患者进行筛查:2002年营养风险筛查(NRS-2002),营养不良通用筛查工具(MUST),微量营养评估(MNA)和短期营养评估问卷(SNAQ)。营养状况使用主观全球评估进行评估。分析了院内死亡率,术后并发症,重症监护病房的住院时间和住院时间。
结果:SNAQ,MUST和NRS-2002对主观全球评估确认的营养不良的敏感度分别为91.5%,97.9%和38.3%,而MNA对老年人的敏感度为81.8%。 SNAQ,MUST和NRS-2002发现的营养不良与术后并发症(赔率[OR]分别为1.75、1.98和1.82)和在重症监护病房停留超过2 d(OR为1.46、1.56,和2.8)。 SNAQ和MUST发现营养不良还与住院时间延长有关(OR 1.49和1.59)。根据多因素logistic回归分析,欧洲心脏手术风险评估系统(OR 1.1,P <0.0001),体外循环时间(OR 1.01,P <0.0001)和MUST(OR)确定的营养不良是独立预测术后并发症的1.2,P = 0.01)。
结论:必须独立预测术后并发症。 SNAQ和MUST在检测营养不良方面具有相当的准确性。术前营养治疗是否可以改善营养不良患者的预后,需要研究。