Kyle Ursula G, Kossovsky Michel P, Karsegard Veronique L, Pichard Claude
Clinical Nutrition, Geneva University Hospital, 1211 Geneva, Switzerland.
Clin Nutr. 2006 Jun;25(3):409-17. doi: 10.1016/j.clnu.2005.11.001. Epub 2005 Dec 13.
This population study aimed to test the sensitivity and specificity of nutritional risk index (NRI), malnutrition universal screening tool (MUST) and nutritional risk screening tool 2002 (NRS-2002) compared to subjective global assessment (SGA) and to evaluate the association between nutritional risk determined by these screening tools and length of hospital stay (LOS).
Patients (n=995) were assessed at hospital admission by four screening tools (SGA, NRI, MUST and NRS-2002). Sensitivity, specificity and predictive values were calculated to evaluate NRI, MUST and NRS-2002 compared to SGA. Multiple logistic regressions, adjusted for age, were used to estimate odds ratios (OR) and confidence interval (CI) for medium and high, compared to low risk in patients hospitalized >11, compared to 1-10 days LOS.
The sensitivity was 62%, 61% and 43% and specificity was 93%, 76% and 89% with the NRS-2002, MUST and NRI, respectively. NRS-2002 had higher positive (85%) and negative predictive values (79%) than the MUST (65% and 76%) or NRI (76% and 66%, respectively). Patients who were severely malnourished or at high nutritional risk by SGA (OR 2.4, CI 1.5-3.9), MUST (OR 3.1, CI 2.1-4.7) and NRS-2002 (OR 2.9, CI 1.7-4.9) were significantly more likely to be hospitalized >11 days, compared to 1-10 days, than patients assessed as low risk.
NRS-2002 had higher sensitivity and specificity than the MUST and NRI, compared to SGA. There was a significant association between LOS and nutritional status and risk by SGA, NRS-2002, MUST and NRI. Nutritional status and risk can be assessed by SGA, NRS-2002 and MUST in patients at hospital admission.
本人群研究旨在测试营养风险指数（NRI）、营养不良通用筛查工具（MUST）和营养风险筛查工具2002（NRS - 2002）相对于主观全面评定法（SGA）的敏感性和特异性，并评估这些筛查工具所确定的营养风险与住院时间（LOS）之间的关联。
对995例患者在入院时采用四种筛查工具（SGA、NRI、MUST和NRS - 2002）进行评估。计算敏感性、特异性和预测值，以评估NRI、MUST和NRS - 2002相对于SGA的情况。采用多因素逻辑回归，对年龄进行校正，以估计住院时间＞11天的患者与住院1 - 10天的患者相比，中高风险与低风险的比值比（OR）和置信区间（CI）。
NRS - 2002、MUST和NRI的敏感性分别为62%、61%和43%，特异性分别为93%、76%和89%。NRS - 2002的阳性预测值（85%）和阴性预测值（79%）高于MUST（分别为65%和76%）或NRI（分别为76%和66%）。与评定为低风险的患者相比，经SGA（OR 2.4，CI 1.5 - 3.9）、MUST（OR 3.1，CI 2.1 - 4.7）和NRS - 2002（OR 2.9，CI 1.7 - 4.9）评定为严重营养不良或高营养风险的患者住院＞11天的可能性显著高于住院1 - 10天的患者。
相对于SGA，NRS - 2002的敏感性和特异性高于MUST和NRI。住院时间与SGA、NRS - 2002、MUST和NRI所评估的营养状况及风险之间存在显著关联。在患者入院时，可通过SGA、NRS - 2002和MUST评估营养状况及风险。
