手术患者营养风险筛查：有效、可行、简便！
Nutritional risk screening in surgery: valid, feasible, easy!
机构信息
Unidade de Nutrição e Metabolismo, Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Avenida Prof Egas Moniz, 1649-028 Lisboa, Portugal.
出版信息
Clin Nutr. 2012 Apr;31(2):206-11. doi: 10.1016/j.clnu.2011.10.003. Epub 2011 Nov 1.
BACKGROUND & AIMS: We aimed to test the capacity in identifying patients at nutritional risk, by comparing BMI, recent %weight loss,Nutritional Risk Screening 2002(NRS-2002),Malnutrition Universal Screening Tool(MUST) and Nutritional Risk Index(NRI) with Subjective Global Assessment(SGA),considered the Standard. The main purpose was to select the most consistent screening method for effective integration in daily surgical wards' practice.
METHODS
300 surgical patients were assessed at admission: BMI(categorized by WHO's criteria), weight loss ≥ 5% in previous 6 months, NRS-2002, MUST, NRI, SGA. Concordances, correlations, sensitivity, specificity, positive(PPV) and negative predictive values(NPV) were calculated to evaluate methods' performance vs the Standard.
RESULTS
Prevalence of nutritional risk was 66% by NRS-2002 + MUST, and 87% by NRI. By SGA, 64% patients were undernourished. All methods agreed with SGA(k = 0.85-0.91,p < 0.001), except BMI & NRI(k = 0.07-0.34,p < 0.05). NRS-2002, MUST and %weight loss effectively detected patients at risk: sensitivity 0.8-0.89, specificity 0.89-0.93, PPV 81%-89%, NPV 89%-100%. Conversely, BMI & NRI were ineffective: sensitivity 0.29-0.43, specificity 0.27-0.39, PPV 24%-35%, NPV 27%-31%; %weight loss alone vs MUST/NRS-2002 was explored: sensitivity 0.79-0.87, specificity 0.85-0.89, PPV 84%-85%, NPV 87%-89%, thus successfully identifying undernutrition risk.
CONCLUSIONS
In surgical patients, MUST + NRS-2002 are valid for nutritional screening; recent weight loss ≥ 5% also proved highly efficient; its easy/quick calculation may facilitate adherence/integration by health professionals as a minimum obligatory in clinical practice.
背景与目的
本研究旨在通过比较 BMI、最近体重减轻百分比、营养风险筛查 2002（NRS-2002）、营养不良通用筛查工具（MUST）和营养风险指数（NRI）与主观整体评估（SGA），以确定哪种方法能够更好地识别存在营养风险的患者，从而选择最有效的筛查方法，并将其有效整合到日常外科病房的实践中。
方法
共评估了 300 例外科患者，入院时评估了 BMI（按世界卫生组织标准分类）、过去 6 个月内体重减轻≥5%、NRS-2002、MUST、NRI 和 SGA。计算一致性、相关性、灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV），以评估各种方法与标准的性能。
结果
NRS-2002+MUST 组的营养风险发生率为 66%，NRI 组为 87%。SGA 组 64%的患者存在营养不良。所有方法与 SGA 均具有一致性（Kappa 值为 0.85-0.91，p＜0.001），但 BMI 和 NRI 与 SGA 之间的一致性较差（Kappa 值为 0.07-0.34，p＜0.05）。NRS-2002、MUST 和体重减轻百分比能够有效检测出存在风险的患者：灵敏度为 0.8-0.89，特异性为 0.89-0.93，PPV 为 81%-89%，NPV 为 89%-100%。相反，BMI 和 NRI 则效果不佳：灵敏度为 0.29-0.43，特异性为 0.27-0.39，PPV 为 24%-35%，NPV 为 27%-31%；单独评估体重减轻百分比与 MUST/NRS-2002 相比：灵敏度为 0.79-0.87，特异性为 0.85-0.89，PPV 为 84%-85%，NPV 为 87%-89%，因此可以有效地识别出营养不良风险。
结论
在外科患者中，MUST+NRS-2002 是有效的营养筛查方法；最近的体重减轻≥5%也被证明是一种非常有效的方法；其简便/快速的计算可能有助于卫生专业人员将其作为临床实践中的最低强制性要求进行遵循/整合。
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