Grass Fabian, Hübner Martin, Schäfer Markus, Ballabeni Pierluigi, Cerantola Yannick, Demartines Nicolas, Pralong François P, Bertrand Pauline Coti
Department of Visceral Surgery, University Hospital CHUV, Bugnon 46, 1011, Lausanne, Switzerland.
Institute for Social and Preventive Medicine, University Hospital CHUV, Lausanne, Switzerland.
Nutr J. 2015 Apr 16;14:37. doi: 10.1186/s12937-015-0024-1.
The aim of the current study was to assess whether widely used nutritional parameters are correlated with the nutritional risk score (NRS-2002) to identify postoperative morbidity and to evaluate the role of nutritionists in nutritional assessment.
A randomized trial on preoperative nutritional interventions (NCT00512213) provided the study cohort of 152 patients at nutritional risk (NRS-2002 ≥3) with a comprehensive phenotyping including diverse nutritional parameters (n=17), elaborated by nutritional specialists, and potential demographic and surgical (n=5) confounders. Risk factors for overall, severe (Dindo-Clavien 3-5) and infectious complications were identified by univariate analysis; parameters with P<0.20 were then entered in a multiple logistic regression model.
Final analysis included 140 patients with complete datasets. Of these, 61 patients (43.6%) were overweight, and 72 patients (51.4%) experienced at least one complication of any degree of severity. Univariate analysis identified a correlation between few (≤3) active co-morbidities (OR=4.94; 95% CI: 1.47-16.56, p=0.01) and overall complications. Patients screened as being malnourished by nutritional specialists presented less overall complications compared to the not malnourished (OR=0.47; 95% CI: 0.22-0.97, p=0.043). Severe postoperative complications occurred more often in patients with low lean body mass (OR=1.06; 95% CI: 1-1.12, p=0.028). Few (≤3) active co-morbidities (OR=8.8; 95% CI: 1.12-68.99, p=0.008) were related with postoperative infections. Patients screened as being malnourished by nutritional specialists presented less infectious complications (OR=0.28; 95% CI: 0.1-0.78), p=0.014) as compared to the not malnourished. Multivariate analysis identified few co-morbidities (OR=6.33; 95% CI: 1.75-22.84, p=0.005), low weight loss (OR=1.08; 95% CI: 1.02-1.14, p=0.006) and low hemoglobin concentration (OR=2.84; 95% CI: 1.22-6.59, p=0.021) as independent risk factors for overall postoperative complications. Compliance with nutritional supplements (OR=0.37; 95% CI: 0.14-0.97, p=0.041) and supplementation of malnourished patients as assessed by nutritional specialists (OR=0.24; 95% CI: 0.08-0.69, p=0.009) were independently associated with decreased infectious complications.
Nutritional support based upon NRS-2002 screening might result in overnutrition, with potentially deleterious clinical consequences. We emphasize the importance of detailed assessment of the nutritional status by a dedicated specialist before deciding on early nutritional intervention for patients with an initial NRS-2002 score of ≥3.
本研究的目的是评估广泛使用的营养参数是否与营养风险评分（NRS - 2002）相关，以识别术后发病率，并评估营养学家在营养评估中的作用。
一项关于术前营养干预的随机试验（NCT00512213）为152名有营养风险（NRS - 2002≥3）的患者提供了研究队列，进行了全面的表型分析，包括由营养专家精心制定的多种营养参数（n = 17）以及潜在的人口统计学和手术（n = 5）混杂因素。通过单因素分析确定总体、严重（Dindo - Clavien 3 - 5级）和感染性并发症的危险因素；然后将P<0.20的参数纳入多元逻辑回归模型。
最终分析纳入了140例具有完整数据集的患者。其中，61例患者（43.6%）超重，72例患者（51.4%）经历了至少一种任何严重程度的并发症。单因素分析确定较少（≤3个）活动性合并症（OR = 4.94；95%CI：1.47 - 16.56，p = 0.01）与总体并发症之间存在相关性。营养专家筛查为营养不良的患者与未营养不良的患者相比，总体并发症较少（OR = 0.47；95%CI：0.22 - 0.97，p = 0.043）。低瘦体重患者术后严重并发症发生率更高（OR = 1.06；95%CI：1 - 1.12，p = 0.028）。较少（≤3个）活动性合并症（OR = 8.8；95%CI：1.12 - 68.99，p =
