Department of Nutritional Sciences, King's College London, London, UK.
Nutrition and Dietetics, King's College Hospital NHS Foundation Trust, London, UK.
J Hum Nutr Diet. 2018 Oct;31(5):683-688. doi: 10.1111/jhn.12553. Epub 2018 Mar 26.
Nutritional screening tools recommended for the general hospitalised population do not always adequately detect malnutrition risk in patients with kidney disease. The present study assessed the validity and reliability of the Nutrition Impact Symptoms (NIS) score as a nutrition screening tool for hospitalised inpatients prefer in nephrology wards.
Nutritional status was classified using Subjective Global Assessment (SGA). NIS scores were calculated from the total score of responses to questions assessing symptoms impacting upon nutritional status from the patient-generated SGA. Concurrent validity of NIS score was assessed using a receiver operating characteristic curve to predict malnutrition risk against SGA. Predictive validity was examined against length of hospital stay (LOS) and 30-day re-admission using Poisson and logistic regression, respectively. Inter-rater reliability of NIS scoring between assessors was determined using intraclass correlation.
In 143 patients [90 males; mean (SD) age 57.8 (15.8) years], malnutrition prevalence was 38% (54/143) using SGA (rating B/C). Predicting malnutrition risk with an NIS score of ≥3 had a sensitivity of 0.89 and a specificity of 0.65 (area under the curve = 0.81 [95% confidence interval (CI) = 0.74-0.88]). For each 1-point increase in NIS score, the model predicted a 1.9% rise in the risk of an increased LOS (P = 0.002). Thirty-day re-admission was not associated with NIS score. Inter-rater reliability was moderate (mean difference = 0.53; intraclass correlation coefficient = 0.74; 95% CI = 0.57-0.85).
Nutrition impact symptoms score is a valid stand-alone nutrition screening tool for identifying malnutrition risk in nephrology inpatients and is associated with LOS.
推荐用于一般住院患者的营养筛查工具并不总是能充分检测出肾病患者的营养风险。本研究评估了营养影响症状（NIS）评分作为肾病病房住院患者营养筛查工具的有效性和可靠性。
使用主观全面评估（SGA）对营养状况进行分类。从患者自评 SGA 评估影响营养状况的症状的总得分中计算出 NIS 得分。使用受试者工作特征曲线评估 NIS 评分预测 SGA 营养不良风险的能力。使用泊松和逻辑回归分别评估预测住院时间（LOS）和 30 天再入院的预测性。使用组内相关系数评估评估者之间 NIS 评分的组内可靠性。
在 143 名患者[90 名男性；平均（SD）年龄 57.8（15.8）岁]中，使用 SGA（评分 B/C）评估营养不良患病率为 38%（54/143）。NIS 评分≥3 预测营养不良风险的敏感性为 0.89，特异性为 0.65（曲线下面积=0.81[95%置信区间（CI）=0.74-0.88]）。NIS 评分每增加 1 分，模型预测 LOS 增加的风险增加 1.9%（P=0.002）。30 天再入院与 NIS 评分无关。组内可靠性为中度（平均差异=0.53；组内相关系数=0.74；95%CI=0.57-0.85）。
营养影响症状评分是一种有效的独立营养筛查工具，可用于识别肾病住院患者的营养不良风险，并与 LOS 相关。
